MEDICARE: LIBERTY LEASING CO., 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	314000000X	Skilled Nursing Facility

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	:	1578740700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY LEASING CO., LLC

Provider Business Mailing Address
First Line	:	4700 ASHWOOD DR
Second Line	:	SUITE 200
City	:	CINCINNATI
State	:	OH
Zip	:	45241-2465
Country	:	US
Telephone Number	:	513-489-7100
Fax Number	:

Provider Business Practice Location Address
First Line	:	4017 LIBERTY HEIGHTS AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21207-7545
Country	:	US
Telephone Number	:	410-542-5306
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF REIMBURSEMENTS
Name	:	JENNIFER CAMPBELL
Credential	:
Telephone Number	:	513-489-7100

Provider Enumeration Date	:	01/30/2008
Last Update Date	:	09/27/2016

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Directions to “LIBERTY LEASING CO., LLC ” Practice Location

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