Healthcare Provider Details

I. General information

NPI: 1578740700
Provider Name (Legal Business Name): LIBERTY LEASING CO., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4017 LIBERTY HEIGHTS AVE
BALTIMORE MD
21207-7545
US

IV. Provider business mailing address

4700 ASHWOOD DR SUITE 200
CINCINNATI OH
45241-2465
US

V. Phone/Fax

Practice location:
  • Phone: 410-542-5306
  • Fax:
Mailing address:
  • Phone: 513-489-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JENNIFER CAMPBELL
Title or Position: DIRECTOR OF REIMBURSEMENTS
Credential:
Phone: 513-489-7100