Provider Demographics
NPI:1427826338
Name:FREEDOM CARE AT BELLA VISTA LLC
Entity type:Organization
Organization Name:FREEDOM CARE AT BELLA VISTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-704-0541
Mailing Address - Street 1:20554 W BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-1836
Mailing Address - Country:US
Mailing Address - Phone:650-704-0541
Mailing Address - Fax:
Practice Address - Street 1:17898 N BELL POINTE BLVD
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3961
Practice Address - Country:US
Practice Address - Phone:928-252-1037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility