Provider Demographics
NPI:1043500432
Name:LIBERTY HEALTHCARE SERVICES, LLC PLUS
Entity Type:Organization
Organization Name:LIBERTY HEALTHCARE SERVICES, LLC PLUS
Other - Org Name:LIBERTY HEALTHCARE SERVICES, LLC PLUS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIENGKEO
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUNEMANY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-747-3356
Mailing Address - Street 1:123 S BROAD ST STE 305
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-4304
Mailing Address - Country:US
Mailing Address - Phone:614-747-3356
Mailing Address - Fax:614-901-3028
Practice Address - Street 1:123 S BROAD ST STE 305
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-4304
Practice Address - Country:US
Practice Address - Phone:614-747-3356
Practice Address - Fax:740-901-3028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-19
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH201108201462251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health