MEDICARE: FREEDOM SENIOR SERVICES OF INDIANA, 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	253Z00000X	In Home Supportive Care Agency	100124561	IN

General Provider Information

NPI Number	:	1386948354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREEDOM SENIOR SERVICES OF INDIANA, INC.

Provider Business Mailing Address
First Line	:	1398 N SHADELAND AVE STE 2231
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-3619
Country	:	US
Telephone Number	:	317-359-3733
Fax Number	:	317-357-2273

Provider Business Practice Location Address
First Line	:	1398 N SHADELAND AVE STE 2231
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-3619
Country	:	US
Telephone Number	:	317-359-3733
Fax Number	:	317-357-2273

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. WALTER E JUSTUS
Credential	:
Telephone Number	:	317-359-3733

Provider Enumeration Date	:	01/05/2011
Last Update Date	:	01/05/2011

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