Provider Demographics
NPI:1033665039
Name:LIBERTY GROUP SENIOR SERVICES
Entity Type:Organization
Organization Name:LIBERTY GROUP SENIOR SERVICES
Other - Org Name:DBA SENIOR DAY OUT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-572-5727
Mailing Address - Street 1:300 PEACHTREE STREET NE
Mailing Address - Street 2:SUITE 21-L
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308
Mailing Address - Country:US
Mailing Address - Phone:404-468-7226
Mailing Address - Fax:404-953-7896
Practice Address - Street 1:1879 GLENWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316
Practice Address - Country:US
Practice Address - Phone:404-468-7226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003175673AMedicaid