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General NPI Number Information
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NPI Number | 1821306580
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Entity Type | Organization
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Legal Business Name | CAREGIVERS OF LIBERTY II
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Dates
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Enumeration Date | 09/15/2010
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Last Update Date | 09/15/2010
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Provider Practice Location Address
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Address Line | 125 E RALEIGH AVE
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City | LIBERTY
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State | NC
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Zip | 27298-3305
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Country | US
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Telephone | 336-622-2348
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Fax |
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Provider Business Mailing Address
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Address Line | 125 E RALEIGH AVE
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City | LIBERTY
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State | NC
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Zip | 27298-3305
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Country | US
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Telephone | 336-622-2348
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Fax |
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Authorized Official
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Title or Position | FINANCIAL MANAGER
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Name | MR. ERNEST ISHMEAL LACKEY
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Credential |
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Telephone | 336-622-2348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | FCL-076-033
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License Number State | NC
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