Healthcare Provider Details

I. General information

NPI: 1902108434
Provider Name (Legal Business Name): LIBERTY HOME HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2010
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8352 SIX FORKS RD STE 104
RALEIGH NC
27615-3056
US

IV. Provider business mailing address

PO BOX 58025
RALEIGH NC
27658-8025
US

V. Phone/Fax

Practice location:
  • Phone: 919-649-4858
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC4205
License Number StateNC

VIII. Authorized Official

Name: UDE OLU
Title or Position: MD
Credential:
Phone: 919-649-4858