Provider Demographics
NPI:1326591009
Name:LIBERTY REHAB, LLC
Entity Type:Organization
Organization Name:LIBERTY REHAB, LLC
Other - Org Name:LIBERTY REHAB & PATIENT AID CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-377-1144
Mailing Address - Street 1:1151 STRATFORD AVE
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615-6312
Mailing Address - Country:US
Mailing Address - Phone:203-377-1144
Mailing Address - Fax:203-377-2244
Practice Address - Street 1:49 PERSHING DR STE 10
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-1406
Practice Address - Country:US
Practice Address - Phone:203-732-4269
Practice Address - Fax:203-732-4062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies