MEDICARE: FREEDOM HEALTH INTERVENTIONAL CENTERS 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	261QM1300X	Multi-Specialty Clinic/Center

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	:	1508364860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREEDOM HEALTH INTERVENTIONAL CENTERS LLC

Provider Business Mailing Address
First Line	:	DEPT# 880391
Second Line	:	P.O BOX 29650
City	:	PHOENIX
State	:	AZ
Zip	:	85038-9650
Country	:	US
Telephone Number	:	480-626-1746
Fax Number	:	480-626-2690

Provider Business Practice Location Address
First Line	:	6036 N 19TH AVE STE 204
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-2104
Country	:	US
Telephone Number	:	480-626-1746
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MATT PEREZ
Credential	:
Telephone Number	:	480-626-1746

Provider Enumeration Date	:	01/31/2018
Last Update Date	:	05/04/2026

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