Healthcare Provider Details

I. General information

NPI: 1053244293
Provider Name (Legal Business Name): LIBERTY COMMUNITY PROGRAMS WV
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 HEDRICK DR
SUGAR GROVE WV
26815-5068
US

IV. Provider business mailing address

133 HEDRICK DR
SUGAR GROVE WV
26815-5068
US

V. Phone/Fax

Practice location:
  • Phone: 925-518-1340
  • Fax:
Mailing address:
  • Phone: 925-518-1340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: FREDERICKA FORD
Title or Position: COO
Credential: MA, MBE
Phone: 925-518-1340