Provider Demographics
NPI:1275813602
Name:LIBERTY CARE AGENCY, LLC
Entity Type:Organization
Organization Name:LIBERTY CARE AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:K
Authorized Official - Last Name:BOBIE-FRIMPONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-497-9137
Mailing Address - Street 1:5210 ASTER PARK DR APT 1712
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-6300
Mailing Address - Country:US
Mailing Address - Phone:513-497-9137
Mailing Address - Fax:
Practice Address - Street 1:5210 ASTER PARK DR APT 1712
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-6300
Practice Address - Country:US
Practice Address - Phone:513-497-9137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0902527261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3053243Medicaid