=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528652336
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FREEDOM CHOICE HOME HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2021
-----------------------------------------------------
Last Update Date | 02/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 63341 PEARL RD
-----------------------------------------------------
City | MONTROSE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81403-9185
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-765-6907
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 63341 PEARL RD
-----------------------------------------------------
City | MONTROSE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 81403-9185
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-765-6907
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CORY PAUL GALLEGOS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 970-765-6907
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------