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NPI Code Detail

MEDICARE: LIBERTY HEALTHCARE GROUP, LLC

MEDICARE: LIBERTY HEALTHCARE GROUP, LLC
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
1314000000XSkilled Nursing FacilityNC

General Provider Information

NPI Number : 1073034138
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIBERTY HEALTHCARE GROUP, LLC
Provider Business Mailing Address
First Line : 44 MCNEILL PLZ
Second Line :
City : WHITEVILLE
State : NC
Zip : 28472-8602
Country : US
Telephone Number : 910-642-0224
Fax Number :
Provider Business Practice Location Address
First Line : 104 HOLCOMBE COVE RD
Second Line :
City : CANDLER
State : NC
Zip : 28715-9452
Country : US
Telephone Number : 828-667-9851
Fax Number :
Authorized Official
Title or Position : CFO
Name : JOSEPH V CALCUTT
Credential :
Telephone Number : 910-815-3122
Provider Enumeration Date : 06/29/2017
Last Update Date : 06/29/2017

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Directions to “LIBERTY HEALTHCARE GROUP, LLC ” Practice Location

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