Healthcare Provider Details

I. General information

NPI: 1619145943
Provider Name (Legal Business Name): LIBERTY OXYGEN AND HOME CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16322 COUNTY ROAD 30
MAPLE GROVE MN
55311-1207
US

IV. Provider business mailing address

4820 PARK GLEN RD
ST LOUIS PARK MN
55416-5702
US

V. Phone/Fax

Practice location:
  • Phone: 763-494-4966
  • Fax: 763-494-4977
Mailing address:
  • Phone: 952-920-0460
  • Fax: 952-920-0480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5677949
License Number StateMN

VIII. Authorized Official

Name: FRANCIS M SHEEHY
Title or Position: PRESIDENT / OWNER
Credential:
Phone: 952-920-0460