Healthcare Provider Details

I. General information

NPI: 1073656716
Provider Name (Legal Business Name): LIBERTY HEALTHCARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 PINCKNEY ST
WHITEVILLE NC
28472-2221
US

IV. Provider business mailing address

2334 S 41ST ST LIBERTY HEALTHCARE MANAGEMENT, INC
WILMINGTON NC
28403-5502
US

V. Phone/Fax

Practice location:
  • Phone: 910-642-7139
  • Fax: 910-642-7187
Mailing address:
  • Phone: 910-815-3122
  • Fax: 910-642-8537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0283
License Number StateNC

VIII. Authorized Official

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