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General NPI Number Information
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NPI Number | 1992880462
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Entity Type | Organization
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Legal Business Name | LIBERTY HOME MEDICAL SUPPLY
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1904 STAR BATT DR
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City | ROCHESTER HILLS
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State | MI
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Zip | 48309-3711
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Country | US
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Telephone | 248-844-9669
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Fax | 248-844-9651
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Provider Business Mailing Address
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Address Line | 20509 NORTHVILLE PARK PL #2006
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City | NORTHVILLE
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State | MI
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Zip | 48167-2939
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Country | US
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Telephone | 248-844-9669
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Fax | 248-844-9651
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. JOHN MICHAEL HAYES
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Credential | RN
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Telephone | 248-844-9669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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