Healthcare Provider Details

I. General information

NPI: 1710244827
Provider Name (Legal Business Name): LIBERTY HEALTHCARE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 VETERANS WAY
KERNERSVILLE NC
27284-9903
US

IV. Provider business mailing address

44 MCNEILL PLZ
WHITEVILLE NC
28472-8602
US

V. Phone/Fax

Practice location:
  • Phone: 336-767-2750
  • Fax: 336-767-3862
Mailing address:
  • Phone: 910-642-0224
  • Fax: 910-642-8537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberNH0439
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateNC

VIII. Authorized Official

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