Healthcare Provider Details

I. General information

NPI: 1851662993
Provider Name (Legal Business Name): LIBERTY HEALTHCARE SERVISES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2012
Last Update Date: 01/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6281 VININGS VINTAGE DR
MABLETON GA
30126-7202
US

IV. Provider business mailing address

6281 VININGS VINTAGE DR
MABLETON GA
30126-7202
US

V. Phone/Fax

Practice location:
  • Phone: 770-630-5721
  • Fax: 770-485-7340
Mailing address:
  • Phone: 770-630-5721
  • Fax: 770-485-7340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number033-R-0804
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number033-R-0804
License Number StateGA

VIII. Authorized Official

Name: EUCHARIA IFEOMA DURU
Title or Position: RN/ADMINISTRATOR
Credential:
Phone: 770-630-5721