Provider Demographics
NPI:1467501361
Name:LIBERTY HOME HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:LIBERTY HOME HEALTH CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EGHAREVBA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:972-423-5400
Mailing Address - Street 1:2225 SUSAN CIR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-3583
Mailing Address - Country:US
Mailing Address - Phone:972-423-5400
Mailing Address - Fax:972-423-5474
Practice Address - Street 1:2225 SUSAN CIR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-3583
Practice Address - Country:US
Practice Address - Phone:972-423-5400
Practice Address - Fax:972-423-5474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
TX679077251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679262Medicare Oscar/Certification
TX679262Medicare ID - Type Unspecified