Provider Demographics
NPI:1568705317
Name:LIBERTY HOUSING SERVICES INC.
Entity Type:Organization
Organization Name:LIBERTY HOUSING SERVICES INC.
Other - Org Name:NEW START
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELNABY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-883-3133
Mailing Address - Street 1:17602 17TH ST STE 102-123
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-1961
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:906 DORMAN ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2523
Practice Address - Country:US
Practice Address - Phone:714-486-3691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIBERTY HOUSING SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-30
Last Update Date:2013-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300249AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility