Healthcare Provider Details

I. General information

NPI: 1982606778
Provider Name (Legal Business Name): LIBERTY INN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5858 HERITAGE PARK WAY
DELRAY BEACH FL
33484-8553
US

IV. Provider business mailing address

5858 HERITAGE PARK WAY
DELRAY BEACH FL
33484-8553
US

V. Phone/Fax

Practice location:
  • Phone: 561-499-2500
  • Fax: 561-495-3962
Mailing address:
  • Phone: 561-499-2500
  • Fax: 561-495-3962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. ROBERT SCHEMEL G SCHEMEL
Title or Position: PRESIDENT OWNER
Credential:
Phone: 561-496-4440