MEDICARE: LIBERTY MEDICAL CARE SERVICES 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	HP 0265700	NJ
2	1041C0700X	Clinical Social Worker

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

General Provider Information

NPI Number	:	1558578369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY MEDICAL CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	1453 SPRINGFIELD AVE # 61
Second Line	:
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-2403
Country	:	US
Telephone Number	:	973-761-8900
Fax Number	:	973-761-4780

Provider Business Practice Location Address
First Line	:	1453 SPRINGFIELD AVE
Second Line	:
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-2403
Country	:	US
Telephone Number	:	973-761-8900
Fax Number	:	973-761-4780

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. CONSTANCE OGUGUO
Credential	:	RN
Telephone Number	:	973-761-8900

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	12/24/2024

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