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General NPI Number Information
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NPI Number | 1487971057
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Entity Type | Organization
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Legal Business Name | LIBERTY LIVING, LLC
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Dates
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Enumeration Date | 04/22/2010
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Last Update Date | 04/22/2010
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Provider Practice Location Address
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Address Line | 70 WOODFIN PL STE 307
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City | ASHEVILLE
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State | NC
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Zip | 28801-2466
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Country | US
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Telephone | 704-922-9130
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Fax | 704-922-7337
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Provider Business Mailing Address
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Address Line | 142 DOWNEY LAKE RD
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City | DALLAS
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State | NC
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Zip | 28034-9395
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Country | US
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Telephone | 704-622-3795
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Fax | 704-922-7337
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. CHARLOTTE DIANE RASH
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Credential | LPN
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Telephone | 704-622-3795
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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