Provider Demographics
NPI:1417057449
Name:LIBERTY ARC
Entity Type:Organization
Organization Name:LIBERTY ARC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-954-3200
Mailing Address - Street 1:43 LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-5635
Mailing Address - Country:US
Mailing Address - Phone:518-842-5080
Mailing Address - Fax:518-954-2009
Practice Address - Street 1:43 LIBERTY DR
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-5635
Practice Address - Country:US
Practice Address - Phone:518-842-5080
Practice Address - Fax:518-954-2009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270374320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities