MEDICARE: LIBERTY GROUP FOUNDATION, 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1508463209
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY GROUP FOUNDATION, LLC

Provider Business Mailing Address
First Line	:	1002 WAVERLY AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607-3736
Country	:	US
Telephone Number	:	419-917-9363
Fax Number	:

Provider Business Practice Location Address
First Line	:	1002 WAVERLY AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43607-3736
Country	:	US
Telephone Number	:	419-917-9363
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JERLENA BRANK
Credential	:
Telephone Number	:	419-917-9363

Provider Enumeration Date	:	10/06/2020
Last Update Date	:	10/06/2020

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Directions to “LIBERTY GROUP FOUNDATION, LLC ” Practice Location

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