Healthcare Provider Details

I. General information

NPI: 1336004639
Provider Name (Legal Business Name): LIBERTY HOME CARE OF MISSOURI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 E SUNRISE HWY STE 413
VALLEY STREAM NY
11581-1233
US

IV. Provider business mailing address

70 E SUNRISE HWY STE 413
VALLEY STREAM NY
11581-1233
US

V. Phone/Fax

Practice location:
  • Phone: 248-329-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CHAVA LIPSETT
Title or Position: RN
Credential: RN
Phone: 248-329-3000