MEDICARE: FREEDOM CARE OF GEORGIA LLC

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

General Provider Information

NPI Number	:	1497414742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREEDOM CARE OF GEORGIA LLC

Provider Business Mailing Address
First Line	:	1979 MARCUS AVE STE C115
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1126
Country	:	US
Telephone Number	:	718-640-6614
Fax Number	:

Provider Business Practice Location Address
First Line	:	756 W PEACHTREE ST NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30308-1118
Country	:	US
Telephone Number	:	407-456-7207
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. YOEL GABAY
Credential	:
Telephone Number	:	718-640-6614

Provider Enumeration Date	:	12/14/2021
Last Update Date	:	12/14/2021

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