Healthcare Provider Details

I. General information

NPI: 1164476636
Provider Name (Legal Business Name): LIBERTY HEALTHCARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CAROLINE AVENUE
WELDON NC
27890-0432
US

IV. Provider business mailing address

2334 SOUTH 41ST STREET LIBERTY HEALTHCARE MANAGEMENT INC
WILMINGTON NC
28403
US

V. Phone/Fax

Practice location:
  • Phone: 252-536-4817
  • Fax: 252-536-5560
Mailing address:
  • Phone: 910-332-1777
  • Fax: 910-815-3114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0469
License Number StateNC

VIII. Authorized Official

Name: MR. JOE CALCUTT
Title or Position: CFO
Credential:
Phone: 910-332-1793