Provider Demographics
NPI:1497080345
Name:LIBERTY HOME HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:LIBERTY HOME HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOJEEB
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHBAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-300-8082
Mailing Address - Street 1:43050 FORD RD STE 110
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3374
Mailing Address - Country:US
Mailing Address - Phone:888-899-6330
Mailing Address - Fax:
Practice Address - Street 1:43050 FORD RD STE 110
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3374
Practice Address - Country:US
Practice Address - Phone:888-899-6330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI987123654Medicare Oscar/Certification