Healthcare Provider Details

I. General information

NPI: 1023481520
Provider Name (Legal Business Name): LIBERTY HEALTHCARE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2015
Last Update Date: 06/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PELT DR
FAYETTEVILLE NC
28301-3412
US

IV. Provider business mailing address

44 MCNEILL PLZ
WHITEVILLE NC
28472-8602
US

V. Phone/Fax

Practice location:
  • Phone: 910-822-0515
  • Fax:
Mailing address:
  • Phone: 910-642-0224
  • Fax: 910-642-8537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JOE CALCUTT
Title or Position: CFO
Credential:
Phone: 910-815-3122