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General NPI Number Information
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NPI Number | 1104145770
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Entity Type | Organization
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Legal Business Name | LIBERTY NURSING REFERRAL SERVICE
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Dates
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Enumeration Date | 05/21/2010
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Last Update Date | 05/21/2010
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Provider Practice Location Address
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Address Line | 101 W 22ND ST SUITE 403
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City | BALTIMORE
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State | MD
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Zip | 21218-5645
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Country | US
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Telephone | 410-333-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 13801 BROWN BRANCH RD
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City | LAUREL
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State | MD
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Zip | 20707-4906
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Country | US
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Telephone | 240-281-8084
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SALAH FATAH
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Credential |
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Telephone | 240-281-8084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 100503
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License Number State | MD
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