Provider Demographics
NPI:1326051251
Name:LIBERTY HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:LIBERTY HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:DOLPH
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-244-1263
Mailing Address - Street 1:888 44TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-3402
Mailing Address - Country:US
Mailing Address - Phone:415-244-1263
Mailing Address - Fax:510-655-3972
Practice Address - Street 1:888 44TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608-3402
Practice Address - Country:US
Practice Address - Phone:415-244-1263
Practice Address - Fax:510-655-3972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44697332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5572100001Medicare NSC