MEDICARE: LIBERTY COMMUNITY PROGRAMS WV

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1053244293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY COMMUNITY PROGRAMS WV

Provider Business Mailing Address
First Line	:	133 HEDRICK DR
Second Line	:
City	:	SUGAR GROVE
State	:	WV
Zip	:	26815-5068
Country	:	US
Telephone Number	:	925-518-1340
Fax Number	:

Provider Business Practice Location Address
First Line	:	133 HEDRICK DR
Second Line	:
City	:	SUGAR GROVE
State	:	WV
Zip	:	26815-5068
Country	:	US
Telephone Number	:	925-518-1340
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	FREDERICKA FORD
Credential	:	MA, MBE
Telephone Number	:	925-518-1340

Provider Enumeration Date	:	06/06/2026
Last Update Date	:	06/06/2026

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Directions to “LIBERTY COMMUNITY PROGRAMS WV ” Practice Location

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