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General NPI Number Information
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NPI Number | 1679528814
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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 | 05/24/2006
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Last Update Date | 12/22/2009
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Provider Practice Location Address
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Address Line | 300 W PENNSYLVANIA AVE
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City | SOUTHERN PINES
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State | NC
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Zip | 28387-5445
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Country | US
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Telephone | 910-246-9882
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Fax | 910-246-9885
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Provider Business Mailing Address
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Address Line | 2334 S 41ST ST
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City | WILMINGTON
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State | NC
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Zip | 28403-5502
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Country | US
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Telephone | 910-815-3122
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Fax | 910-815-3111
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Authorized Official
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Title or Position | PRESIDENT/EXECUTIVE DIRECTOR
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Name | MR. ANTHONY J ZIZZAMIA JR.
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Credential | RN
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HC0002
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License Number State | NC
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