Provider Demographics
NPI:1104591387
Name:FREEDOM WOUND CARE LLC
Entity type:Organization
Organization Name:FREEDOM WOUND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RODELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:YUKEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-910-1587
Mailing Address - Street 1:4889 WILLOW GLEN DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-5266
Mailing Address - Country:US
Mailing Address - Phone:170-291-0158
Mailing Address - Fax:
Practice Address - Street 1:2965 S JONES BLVD STE E4
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5606
Practice Address - Country:US
Practice Address - Phone:702-910-1587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-10
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty