Provider Demographics
NPI:1053652743
Name:OPERATION LIBERATE HOME CARE AGENCY
Entity Type:Organization
Organization Name:OPERATION LIBERATE HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:NASHELLE
Authorized Official - Last Name:TOLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-249-3554
Mailing Address - Street 1:2504 RAEFORD RD STE 208/210
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5135
Mailing Address - Country:US
Mailing Address - Phone:910-223-2751
Mailing Address - Fax:910-223-2759
Practice Address - Street 1:2504 RAEFORD RD STE 208210
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5294
Practice Address - Country:US
Practice Address - Phone:910-223-2751
Practice Address - Fax:910-223-2759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4154253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care