Provider Demographics
NPI:1275996431
Name:LIBERTY POINT RESIDENTAL TREATMENT CENTER
Entity Type:Organization
Organization Name:LIBERTY POINT RESIDENTAL TREATMENT CENTER
Other - Org Name:UNITED HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHIATRY
Authorized Official - Prefix:DR
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:G
Authorized Official - Last Name:MOULTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-213-0450
Mailing Address - Street 1:1110 MONTGOMERGY AVENUE
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401
Mailing Address - Country:US
Mailing Address - Phone:540-213-0450
Mailing Address - Fax:540-213-0480
Practice Address - Street 1:1110 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-3968
Practice Address - Country:US
Practice Address - Phone:540-213-0450
Practice Address - Fax:540-213-0480
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNITED HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040563320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities