Provider Demographics
NPI:1518560473
Name:AMERICAN LIBERTY HOME CARE
Entity Type:Organization
Organization Name:AMERICAN LIBERTY HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERMAINE
Authorized Official - Middle Name:DAMIAN
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-304-3580
Mailing Address - Street 1:4410 PAUL ST UNIT 4827
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-3759
Mailing Address - Country:US
Mailing Address - Phone:267-304-3580
Mailing Address - Fax:
Practice Address - Street 1:12134 MEDFORD RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-1825
Practice Address - Country:US
Practice Address - Phone:267-304-3580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care