Healthcare Provider Details

I. General information

NPI: 1578118089
Provider Name (Legal Business Name): LIBERTY HEALTHCARE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2019
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 SMOKETREE WAY
LOUISBURG NC
27549-2117
US

IV. Provider business mailing address

44 MCNEILL PLZ
WHITEVILLE NC
28472-8602
US

V. Phone/Fax

Practice location:
  • Phone: 919-496-6084
  • Fax:
Mailing address:
  • Phone: 910-642-0224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

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