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General NPI Number Information
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NPI Number | 1457033359
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Entity Type | Organization
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Legal Business Name | LIBERTY RESIDENTIAL CARE LLC
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Dates
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Enumeration Date | 08/01/2023
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 19401 YONKA ST
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City | DETROIT
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State | MI
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Zip | 48234-1827
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Country | US
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Telephone | 248-979-1990
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Fax |
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Provider Business Mailing Address
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Address Line | 28475 GREENFIELD RD
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City | SOUTHFIELD
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State | MI
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Zip | 48076-3034
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Country | US
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Telephone | 248-979-1990
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MS. CYNTHIA BOWDEN
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Credential |
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Telephone | 248-979-1990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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