Healthcare Provider Details

I. General information

NPI: 1972050276
Provider Name (Legal Business Name): LIBERTY HEALTHCARE GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2016
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 MCNEILL PLZ
WHITEVILLE NC
28472-8602
US

IV. Provider business mailing address

864 US HWY 158 BUSINESS WEST
WARRENTON NC
27589-0618
US

V. Phone/Fax

Practice location:
  • Phone: 910-642-0224
  • Fax: 910-642-8537
Mailing address:
  • Phone: 252-257-2011
  • Fax: 252-257-5164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

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