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General NPI Number Information
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NPI Number | 1851662993
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Entity Type | Organization
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Legal Business Name | LIBERTY HEALTHCARE SERVISES INC.
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Dates
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Enumeration Date | 01/20/2012
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Last Update Date | 01/20/2012
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Provider Practice Location Address
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Address Line | 6281 VININGS VINTAGE DR
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City | MABLETON
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State | GA
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Zip | 30126-7202
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Country | US
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Telephone | 770-630-5721
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Fax | 770-485-7340
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Provider Business Mailing Address
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Address Line | 6281 VININGS VINTAGE DR
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City | MABLETON
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State | GA
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Zip | 30126-7202
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Country | US
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Telephone | 770-630-5721
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Fax | 770-485-7340
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Authorized Official
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Title or Position | RN/ADMINISTRATOR
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Name | EUCHARIA IFEOMA DURU
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Credential |
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Telephone | 770-630-5721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | 033-R-0804
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 033-R-0804
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License Number State | GA
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