Healthcare Provider Details

I. General information

NPI: 1265569032
Provider Name (Legal Business Name): LIBERTY NURSING SERVICES II, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 SHAMROCK DR
CHARLOTTE NC
28215-3218
US

IV. Provider business mailing address

2334 S 41ST ST
WILMINGTON NC
28403-5502
US

V. Phone/Fax

Practice location:
  • Phone: 704-940-8367
  • Fax: 704-940-7458
Mailing address:
  • Phone: 910-815-3122
  • Fax: 910-815-3111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberHC2363
License Number StateNC

VIII. Authorized Official

Name: MR. RONALD B MCNEILL
Title or Position: MANAGER
Credential:
Phone: 910-815-3122