Provider Demographics
NPI:1568167625
Name:LIBERTY ESTATES LLC
Entity Type:Organization
Organization Name:LIBERTY ESTATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETHANY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CLC
Authorized Official - Phone:503-420-3223
Mailing Address - Street 1:4300 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-9254
Mailing Address - Country:US
Mailing Address - Phone:503-420-3223
Mailing Address - Fax:
Practice Address - Street 1:4300 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-9254
Practice Address - Country:US
Practice Address - Phone:503-420-3223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care