Healthcare Provider Details

I. General information

NPI: 1831065838
Provider Name (Legal Business Name): LIBERTY ELITE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5754 BALSAM DR
LIBERTY TOWNSHIP OH
45044-8602
US

IV. Provider business mailing address

5754 BALSAM DR
LIBERTY TOWNSHIP OH
45044-8602
US

V. Phone/Fax

Practice location:
  • Phone: 513-808-8872
  • Fax: 413-442-2050
Mailing address:
  • Phone: 513-808-8872
  • Fax: 513-442-2050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: SHEENA KAMBULE
Title or Position: DO
Credential:
Phone: 513-808-8872