Provider Demographics
NPI:1215255641
Name:FREEDOM LIVING CENTER, LLC
Entity type:Organization
Organization Name:FREEDOM LIVING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUNNY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-796-5001
Mailing Address - Street 1:306 TOUPIN STREET
Mailing Address - Street 2:STE #300
Mailing Address - City:OKLEE
Mailing Address - State:MN
Mailing Address - Zip Code:56742
Mailing Address - Country:US
Mailing Address - Phone:218-796-5001
Mailing Address - Fax:218-796-5003
Practice Address - Street 1:306 TOUPIN STREET
Practice Address - Street 2:STE #300
Practice Address - City:OKLEE
Practice Address - State:MN
Practice Address - Zip Code:56742
Practice Address - Country:US
Practice Address - Phone:218-796-5001
Practice Address - Fax:218-796-5003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN348037310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility