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General NPI Number Information
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NPI Number | 1376577627
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Entity Type | Organization
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Legal Business Name | LIBERTY REGIONAL FOUNDATION, INC.
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 474 S MAIN ST
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City | HINESVILLE
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State | GA
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Zip | 31313-4339
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Country | US
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Telephone | 912-369-9420
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Fax | 912-368-4258
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Provider Business Mailing Address
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Address Line | PO BOX 115
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City | HINESVILLE
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State | GA
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Zip | 31310-0115
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Country | US
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Telephone | 912-369-9420
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Fax | 912-368-4258
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Authorized Official
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Title or Position | ADMINSTRATIVE COORDINATOR
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Name | MRS. REBECCA SHUMAN
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Credential |
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Telephone | 912-369-9420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 089-02
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License Number State | GA
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