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General NPI Number Information
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NPI Number | 1629535455
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Entity Type | Organization
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Legal Business Name | LIBERTY HEALTHCARE GROUP, LLC
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Dates
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Enumeration Date | 02/28/2019
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Last Update Date | 08/10/2021
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Provider Practice Location Address
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Address Line | 621 CHESTNUT RIDGE PKWY
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City | BLOWING ROCK
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State | NC
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Zip | 28605-8962
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Country | US
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Telephone | 828-386-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 621 CHESTNUT RIDGE PKWY
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City | BLOWING ROCK
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State | NC
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Zip | 28605-8962
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Country | US
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Telephone | 828-386-3300
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | JOSEPH V CALCUTT
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Credential |
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Telephone | 910-815-3122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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