Provider Demographics
NPI:1386948354
Name:FREEDOM SENIOR SERVICES OF INDIANA, INC.
Entity type:Organization
Organization Name:FREEDOM SENIOR SERVICES OF INDIANA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:E
Authorized Official - Last Name:JUSTUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-359-3733
Mailing Address - Street 1:1398 N SHADELAND AVE STE 2231
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-3619
Mailing Address - Country:US
Mailing Address - Phone:317-359-3733
Mailing Address - Fax:317-357-2273
Practice Address - Street 1:1398 N SHADELAND AVE STE 2231
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3619
Practice Address - Country:US
Practice Address - Phone:317-359-3733
Practice Address - Fax:317-357-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN100124561253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care