Healthcare Provider Details

I. General information

NPI: 1205979580
Provider Name (Legal Business Name): LIBERTY HEALTHCARE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 CONNER DR
WINDSOR NC
27983-8514
US

IV. Provider business mailing address

2334 S 41ST ST
WILMINGTON NC
28403-5502
US

V. Phone/Fax

Practice location:
  • Phone: 252-794-4441
  • Fax: 252-794-2800
Mailing address:
  • Phone: 910-332-8155
  • Fax: 910-642-8537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNH0522
License Number StateNC

VIII. Authorized Official

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