Provider Demographics
NPI:1407363724
Name:LIBERTY PUBLIC HEALTH
Entity Type:Organization
Organization Name:LIBERTY PUBLIC HEALTH
Other - Org Name:LPH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GARIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:EDDINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-403-6677
Mailing Address - Street 1:6519 TERSCOTT CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-1480
Mailing Address - Country:US
Mailing Address - Phone:267-403-6677
Mailing Address - Fax:
Practice Address - Street 1:6519 TERSCOTT CT
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-1480
Practice Address - Country:US
Practice Address - Phone:267-403-6677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities