Healthcare Provider Details

I. General information

NPI: 1245615087
Provider Name (Legal Business Name): LIBERTY CORNER ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2015
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 NELLIE JOHN DR
CLYDE NC
28721-7006
US

IV. Provider business mailing address

119 TUNNEL RD. SUITE 120A
ASHEVILLE NC
28805-1107
US

V. Phone/Fax

Practice location:
  • Phone: 828-627-1997
  • Fax:
Mailing address:
  • Phone: 828-254-9917
  • Fax: 828-251-5373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. GRETA BYRD
Title or Position: EXECUTIVE DIRECTOR
Credential: MBA
Phone: 828-254-9917