Provider Demographics
NPI:1437471653
Name:LIBERTY HEALTH SUPPLIES LLC
Entity Type:Organization
Organization Name:LIBERTY HEALTH SUPPLIES LLC
Other - Org Name:LIBERTY REHAB & PATIENT AID CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FLETCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-732-4269
Mailing Address - Street 1:49 PERSHING DR
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-1437
Mailing Address - Country:US
Mailing Address - Phone:203-732-4269
Mailing Address - Fax:203-732-4062
Practice Address - Street 1:49 PERSHING DR
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-1437
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:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0285908332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT171441OtherWELLCARE OF CONNECTICUT
CT772608OtherCONNECTICARE
CT2V6016OtherHEALTHNET
CT8202085OtherEVERCARE
CT12DME0968CT01OtherANTHEM BLUE CROSS & BLUE SHIELD
CT=========OtherAMERICHOICE
CT171441OtherWELLCARE OF CONNECTICUT
CT=========OtherHUMANA MEDICARE
CT12DME0968CT01OtherANTHEM BLUE CROSS & BLUE SHIELD
CT772608OtherCONNECTICARE
CT2V6016OtherHEALTHNET
CT8202085OtherEVERCARE