Provider Demographics
NPI:1477729960
Name:LOYD'S LIBERTY HOMES, INC
Entity Type:Organization
Organization Name:LOYD'S LIBERTY HOMES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARGMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-483-2505
Mailing Address - Street 1:3649 W BEECHWOOD AVE
Mailing Address - Street 2:STE106
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-0693
Mailing Address - Country:US
Mailing Address - Phone:559-451-0399
Mailing Address - Fax:559-451-0345
Practice Address - Street 1:5704 N WHEELER AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-2541
Practice Address - Country:US
Practice Address - Phone:559-451-0399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MENTOR NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040000543315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities