Provider Demographics
NPI:1053402768
Name:FREEDOM DIABETIC SUPPLIES, INC.
Entity type:Organization
Organization Name:FREEDOM DIABETIC SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:C
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-221-4532
Mailing Address - Street 1:4407 PROVIDENCE LN STE B
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3264
Mailing Address - Country:US
Mailing Address - Phone:910-221-4532
Mailing Address - Fax:910-221-7835
Practice Address - Street 1:4407 PROVIDENCE LN STE B
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3264
Practice Address - Country:US
Practice Address - Phone:910-221-4532
Practice Address - Fax:910-221-7835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies