Provider Demographics
NPI:1558578369
Name:LIBERTY MEDICAL CARE SERVICES LLC
Entity Type:Organization
Organization Name:LIBERTY MEDICAL CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:OGUGUO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:973-761-8900
Mailing Address - Street 1:1859 SPRINGFIELD AVE # 61
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-2904
Mailing Address - Country:US
Mailing Address - Phone:973-761-8900
Mailing Address - Fax:973-761-4780
Practice Address - Street 1:1859 SPRINGFIELD AVE # 61
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-2904
Practice Address - Country:US
Practice Address - Phone:973-761-8900
Practice Address - Fax:973-761-4780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP 0265700251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0104442Medicaid