Healthcare Provider Details

I. General information

NPI: 1811611577
Provider Name (Legal Business Name): LIBERTY COMMONS NURSING AND REHABILITATION CENTER OF HIGHLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 PAMALEE DR
FAYETTEVILLE NC
28301-2824
US

IV. Provider business mailing address

44 MCNEILL PLZ
WHITEVILLE NC
28472-8602
US

V. Phone/Fax

Practice location:
  • Phone: 910-488-2295
  • Fax: 910-488-0087
Mailing address:
  • Phone: 910-642-0224
  • Fax: 910-642-8537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY WILSON
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 910-815-3122