Provider Demographics
NPI:1073264826
Name:LIBERTY CARE MANAGEMENT, LLC
Entity Type:Organization
Organization Name:LIBERTY CARE MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:CABELL
Authorized Official - Last Name:GRAGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-337-8964
Mailing Address - Street 1:5906 GREEN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2520
Mailing Address - Country:US
Mailing Address - Phone:336-337-8964
Mailing Address - Fax:
Practice Address - Street 1:8005 N POINT BLVD STE H
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3267
Practice Address - Country:US
Practice Address - Phone:336-759-7207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care