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General NPI Number Information
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NPI Number | 1568690295
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Entity Type | Organization
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Legal Business Name | FREEDOM TRAIL ENTERPRISES INC.
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Dates
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Enumeration Date | 07/01/2009
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Last Update Date | 07/01/2009
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Provider Practice Location Address
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Address Line | 361 PALMER ST
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City | DELTA
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State | CO
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Zip | 81416-1735
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Country | US
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Telephone | 970-874-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 361 PALMER ST
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City | DELTA
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State | CO
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Zip | 81416-1735
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TRACEY QUIST
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Credential |
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Telephone | 970-874-1400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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