Healthcare Provider Details

I. General information

NPI: 1912920174
Provider Name (Legal Business Name): LIBERTY HEALTHCARE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 HENDERSON DR
JACKSONVILLE NC
28546-5247
US

IV. Provider business mailing address

2334 S 41ST ST
WILMINGTON NC
28403-5502
US

V. Phone/Fax

Practice location:
  • Phone: 910-355-1996
  • Fax: 910-455-7665
Mailing address:
  • Phone: 910-815-3122
  • Fax: 910-815-3114

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 Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

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