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General NPI Number Information
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NPI Number | 1316754088
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Entity Type | Organization
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Legal Business Name | AT LIBERTY PLACE LLC,
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Dates
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Enumeration Date | 12/16/2024
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 1655 SWEDESBORO AVE
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City | PAULSBORO
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State | NJ
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Zip | 08066-1533
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Country | US
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Telephone | 856-294-7979
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Fax | 856-599-1379
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Provider Business Mailing Address
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Address Line | 1655 SWEDESBORO AVE
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City | PAULSBORO
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State | NJ
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Zip | 08066-1533
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Country | US
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Telephone | 856-294-7979
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Fax |
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Authorized Official
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Title or Position | CHEIF OF EXCEUTIVE
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Name | MRS. REMENDA RENEAKE CHARLES
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Credential |
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Telephone | 856-294-7979
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 310500000X
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Taxonomy Name | Mental Illness Intermediate Care Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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