Freedom Co-Op

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

L000000009711 Issued in TN

Legal business name

FREEDOM CO-OP

Practice address

1633 Madison Ave
Memphis, TN 38104-2506

Phone

(901) 726-6404

NPI assigned

Nov 13, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Tom Nunnikhoven

Title

Board Chair

Phone

(901) 833-9744

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1321142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321142400000",
    "number": "1598042962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1633 MADISON AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381042506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1633 MADISON AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381042506",
            "telephone_number": "901-726-6404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREEDOM CO-OP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-13",
        "last_updated": "2011-11-13",
        "status": "A",
        "authorized_official_last_name": "NUNNIKHOVEN",
        "authorized_official_first_name": "TOM",
        "authorized_official_title_or_position": "BOARD CHAIR",
        "authorized_official_telephone_number": "901-833-9744",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "TN",
            "license": "L000000009711",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "G29",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Freedom 2 Go Biomed & Permitting, Inc (Freedom 2 Go)
• Freedom Care of Tennessee LLC
• Andrea Lynette Freeman
• Charlotte M Freeman, PHD
• Daniel Derrick Freeman, DDS
• Donna Gateley Freeman, FNP-BC
• Elmo Chester Freeman Jr., DPH

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Memphis, TN
• Providers in Memphis, TN by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.