MEDICARE: LOYD'S LIBERTY HOMES, INC

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	315P00000X	Intellectual Disabilities Intermediate Care Facility	1200171	CA

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	:	1629284088
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOYD'S LIBERTY HOMES, INC

Provider Business Mailing Address
First Line	:	3649 W BEECHWOOD AVE
Second Line	:	STE 106
City	:	FRESNO
State	:	CA
Zip	:	93711-0693
Country	:	US
Telephone Number	:	559-451-0399
Fax Number	:	559-451-0141

Provider Business Practice Location Address
First Line	:	2518 NEWPORT LN
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93309-4357
Country	:	US
Telephone Number	:	559-451-0399
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	NANCY BARGMANN
Credential	:
Telephone Number	:	909-579-3151

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	08/22/2020

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