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General NPI Number Information
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NPI Number | 1407365257
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Entity Type | Organization
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Legal Business Name | LIBERTY COMMUNITY CONNECTIONS, INC
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Dates
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Enumeration Date | 09/25/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 112 N 8TH ST STE 602
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City | PHILADELPHIA
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State | PA
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Zip | 19107
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Country | US
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Telephone | 267-765-1515
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Fax |
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Provider Business Mailing Address
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Address Line | 112 N 8TH ST STE 602
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City | PHILADELPHIA
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State | PA
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Zip | 19107-2422
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Country | US
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Telephone | 267-765-1515
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Fax |
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Authorized Official
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Title or Position | CO-EXECUTIVE DIRECTOR
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Name | ELIZABETH THUL
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Credential |
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Telephone | 267-765-1515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 102749306
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 102749306
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License Number State | PA
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