MEDICARE: FREEDOM OAKS ASSISTED LIVING, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164037529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREEDOM OAKS ASSISTED LIVING, INC.

Provider Business Mailing Address
First Line	:	579 JOHNSON LAKE RD
Second Line	:
City	:	DE LEON SPRINGS
State	:	FL
Zip	:	32130-3636
Country	:	US
Telephone Number	:	386-277-2010
Fax Number	:	386-277-2010

Provider Business Practice Location Address
First Line	:	579 JOHNSON LAKE RD
Second Line	:
City	:	DE LEON SPRINGS
State	:	FL
Zip	:	32130-3636
Country	:	US
Telephone Number	:	386-277-2010
Fax Number	:	386-277-2010

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ERICA HULL
Credential	:
Telephone Number	:	386-316-4633

Provider Enumeration Date	:	09/12/2020
Last Update Date	:	09/22/2020

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