Provider Demographics
NPI:1023179876
Name:LIBERTY HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:LIBERTY HEALTH SERVICES, INC.
Other - Org Name:ROZE ROOM HOSPICE OF VENTURA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LENA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-938-1155
Mailing Address - Street 1:5675 RALSTON ST STE C
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6236
Mailing Address - Country:US
Mailing Address - Phone:323-938-1155
Mailing Address - Fax:323-936-7573
Practice Address - Street 1:5675 RALSTON ST
Practice Address - Street 2:SUITE 'C'
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6005
Practice Address - Country:US
Practice Address - Phone:805-654-0191
Practice Address - Fax:805-654-0103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000185251G00000X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA051795Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER