MEDICARE: LIBERTY CORNER ENTERPRISES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251C00000X	Developmentally Disabled Services Day Training Agency
3	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
4	332B00000X	Durable Medical Equipment & Medical Supplies
5	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437526951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY CORNER ENTERPRISES, INC.

Provider Business Mailing Address
First Line	:	723 FAIRVIEW RD
Second Line	:
City	:	ASHEVILLE
State	:	NC
Zip	:	28803-1107
Country	:	US
Telephone Number	:	828-254-9917
Fax Number	:	828-251-5373

Provider Business Practice Location Address
First Line	:	142 WALNUT VALLEY LN
Second Line	:
City	:	WAYNESVILLE
State	:	NC
Zip	:	28786-9560
Country	:	US
Telephone Number	:	828-593-0153
Fax Number	:

Authorized Official
Title or Position	:	BOOKKEEPER
Name	:	JULIE CROSSON
Credential	:
Telephone Number	:	828-254-9917

Provider Enumeration Date	:	09/01/2015
Last Update Date	:	09/01/2015

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Directions to “LIBERTY CORNER ENTERPRISES, INC. ” Practice Location

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