Provider Demographics
NPI:1518367523
Name:LIBERTY SENIOR CARE LLC
Entity Type:Organization
Organization Name:LIBERTY SENIOR CARE LLC
Other - Org Name:LIBERTY SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:RAWANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-518-9710
Mailing Address - Street 1:2803 FRUITVILLE RD
Mailing Address - Street 2:SUITE 236
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-5344
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2803 FRUITVILLE RD
Practice Address - Street 2:SUITE 236
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-5344
Practice Address - Country:US
Practice Address - Phone:941-518-9710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care