Healthcare Provider Details

I. General information

NPI: 1942146212
Provider Name (Legal Business Name): LIBERTY OAKS ALF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12167 NW FREEMAN RD
BRISTOL FL
32321-3019
US

IV. Provider business mailing address

12167 NW FREEMAN RD
BRISTOL FL
32321-3019
US

V. Phone/Fax

Practice location:
  • Phone: 850-643-5155
  • Fax: 850-643-3721
Mailing address:
  • Phone: 850-643-5155
  • Fax: 850-643-3721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY ROSS
Title or Position: ADMINISTRATOR/OWNER
Credential: ROSS
Phone: 850-643-5155