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General NPI Number Information
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NPI Number | 1962875435
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Entity Type | Organization
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Legal Business Name | LIBERTY COMMUNITY HEALTH CARE, INC
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Dates
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Enumeration Date | 11/05/2015
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Last Update Date | 01/04/2017
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Provider Practice Location Address
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Address Line | 17316 NE STATE ROAD 65
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City | HOSFORD
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State | FL
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Zip | 32334-2415
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Country | US
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Telephone | 850-379-5800
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Fax | 850-379-5811
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Provider Business Mailing Address
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Address Line | 17316 NE STATE ROAD 65
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City | HOSFORD
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State | FL
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Zip | 32334-2415
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Country | US
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Telephone | 850-379-5800
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Fax | 850-379-5811
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MRS. PEGGY DEASON HOWLAND
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Credential |
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Telephone | 850-379-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | OS7759
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License Number State | FL
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