Healthcare Provider Details

I. General information

NPI: 1740237957
Provider Name (Legal Business Name): LIBERTY HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2608 CARVER ST
DURHAM NC
27705-2797
US

IV. Provider business mailing address

2334 S 41ST ST
WILMINGTON NC
28403-5502
US

V. Phone/Fax

Practice location:
  • Phone: 919-471-1368
  • Fax: 919-620-3659
Mailing address:
  • Phone: 910-815-3122
  • Fax: 910-815-3111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC1176
License Number StateNC

VIII. Authorized Official

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