Provider Demographics
NPI:1336108075
Name:LIBERTY HOME CARE, INC.
Entity Type:Organization
Organization Name:LIBERTY HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MANALO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-377-6000
Mailing Address - Street 1:150 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-6443
Mailing Address - Country:US
Mailing Address - Phone:201-377-6000
Mailing Address - Fax:201-377-6083
Practice Address - Street 1:150 WARREN ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-6443
Practice Address - Country:US
Practice Address - Phone:201-377-6000
Practice Address - Fax:201-377-6083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22363251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3690407Medicaid
NJ3690415Medicaid
NJ3690415Medicaid