Provider Demographics
NPI:1558977454
Name:LIBERTY HEALTHCARE SERVICES INC
Entity Type:Organization
Organization Name:LIBERTY HEALTHCARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:COBBOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:240-988-2428
Mailing Address - Street 1:8303 CURRY PL
Mailing Address - Street 2:
Mailing Address - City:ADELPHI
Mailing Address - State:MD
Mailing Address - Zip Code:20783-1728
Mailing Address - Country:US
Mailing Address - Phone:240-988-2428
Mailing Address - Fax:
Practice Address - Street 1:8303 CURRY PL
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-1728
Practice Address - Country:US
Practice Address - Phone:240-988-2428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1522077581Medicaid