Provider Demographics
NPI:1588740229
Name:FREEDOM PROPERTIES-HEMET LLC
Entity type:Organization
Organization Name:FREEDOM PROPERTIES-HEMET LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-612-4657
Mailing Address - Street 1:2400 W ACACIA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-3743
Mailing Address - Country:US
Mailing Address - Phone:951-766-5116
Mailing Address - Fax:951-658-5629
Practice Address - Street 1:2400 W ACACIA AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-3743
Practice Address - Country:US
Practice Address - Phone:951-766-5116
Practice Address - Fax:951-658-5629
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FREEDOM PROPERTIES-HEMET LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-27
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33643573310400000X
CA250000405314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA555463Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER