Provider Demographics
NPI:1295217354
Name:LIBERTY WELLNESS
Entity Type:Organization
Organization Name:LIBERTY WELLNESS
Other - Org Name:ADDICTION RECOVERY CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:OSVALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-212-5200
Mailing Address - Street 1:20 E TAUNTON ROAD SUITE 103
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BERLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08009
Mailing Address - Country:US
Mailing Address - Phone:833-542-9355
Mailing Address - Fax:833-542-9355
Practice Address - Street 1:20 E TAUNTON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BERLIN
Practice Address - State:NJ
Practice Address - Zip Code:08009
Practice Address - Country:US
Practice Address - Phone:833-542-9355
Practice Address - Fax:833-542-9355
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADDICTION RECOVERY CONSULTANTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-05
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility