MEDICARE: LIBERTY HOSPICE HOUSE OF GREENVILLE, 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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1679413736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY HOSPICE HOUSE OF GREENVILLE, LLC

Provider Business Mailing Address
First Line	:	920 WELLNESS DR
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-8040
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 WELLNESS DR
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-8040
Country	:	US
Telephone Number	:	910-840-2955
Fax Number	:

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	DR. JOHN WILLIAM WATSON
Credential	:	RPH
Telephone Number	:	910-840-2955

Provider Enumeration Date	:	03/30/2026
Last Update Date	:	03/30/2026

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