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General NPI Number Information
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NPI Number | 1790284941
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Entity Type | Organization
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Legal Business Name | LIBERTY RESOURCES HEALTH AND WELLNESS, LLC
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Dates
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Enumeration Date | 02/02/2018
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Last Update Date | 02/02/2018
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Provider Practice Location Address
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Address Line | 112 N 8TH ST STE 600
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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 | 215-634-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 112 N 8TH ST STE 600
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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 |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | FERMINA MADDOX
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Credential |
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Telephone | 215-634-2000
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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 | 06670501
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License Number State | PA
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