Provider Demographics
NPI:1124218573
Name:LIBERTY ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:LIBERTY ASSISTED LIVING LLC
Other - Org Name:HOME AWAY FROM HOME OF MARYVILLE, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SORRELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-256-2797
Mailing Address - Street 1:312 MCMASTER PL
Mailing Address - Street 2:LIBERTY ASSISTED LIVING LLC
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801
Mailing Address - Country:US
Mailing Address - Phone:865-984-7047
Mailing Address - Fax:865-984-8722
Practice Address - Street 1:312 MCMASTER PL
Practice Address - Street 2:LIBERTY ASSISTED LIVING LLC
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801
Practice Address - Country:US
Practice Address - Phone:865-984-7047
Practice Address - Fax:865-984-8722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility