Provider Demographics
NPI:1124774310
Name:FREEDOM & WISH, INC.
Entity type:Organization
Organization Name:FREEDOM & WISH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAWEH
Authorized Official - Middle Name:
Authorized Official - Last Name:ETMINAN-RAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-360-3696
Mailing Address - Street 1:1845 SUNDOWNER LN
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:MT
Mailing Address - Zip Code:59875-9725
Mailing Address - Country:US
Mailing Address - Phone:406-360-3696
Mailing Address - Fax:
Practice Address - Street 1:1845 SUNDOWNER LN
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:MT
Practice Address - Zip Code:59875-9725
Practice Address - Country:US
Practice Address - Phone:406-360-3696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No385H00000XRespite Care FacilityRespite Care