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General NPI Number Information
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NPI Number | 1962603142
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Entity Type | Organization
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Legal Business Name | LIBERTY HEALTHCARE SYSTEMS
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4673 EUGENE WARE BLVD
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City | BASTROP
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State | LA
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Zip | 71220-1425
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Country | US
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Telephone | 318-281-2448
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Fax | 318-281-2499
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Provider Business Mailing Address
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Address Line | 4673 EUGENE WARE BLVD
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City | BASTROP
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State | LA
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Zip | 71220-1425
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Country | US
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Telephone | 318-281-2448
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Fax | 318-281-2499
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Authorized Official
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Title or Position | CFO
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Name | MR. RADIAN HENNIGAN
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Credential |
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Telephone | 318-251-9458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 573
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License Number State | LA
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