MEDICARE: LIBERTY NURSING SERVICES II, 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
1	251J00000X	Nursing Care Agency	HC2844	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437294600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY NURSING SERVICES II, LLC

Provider Business Mailing Address
First Line	:	2334 S 41ST ST
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-5502
Country	:	US
Telephone Number	:	910-815-3122
Fax Number	:	910-815-3111

Provider Business Practice Location Address
First Line	:	1317 N BRIGHTLEAF BLVD STE C
Second Line	:
City	:	SMITHFIELD
State	:	NC
Zip	:	27577-7267
Country	:	US
Telephone Number	:	919-989-6792
Fax Number	:	919-989-8519

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. RONALD B MCNEILL
Credential	:
Telephone Number	:	910-815-3122

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	09/21/2007

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