Provider Demographics
NPI:1578217816
Name:LIBERTY REHABILITATION CENTER
Entity Type:Organization
Organization Name:LIBERTY REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-598-5610
Mailing Address - Street 1:749 TATE AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38126-3616
Mailing Address - Country:US
Mailing Address - Phone:901-691-6950
Mailing Address - Fax:
Practice Address - Street 1:749 TATE AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38126-3616
Practice Address - Country:US
Practice Address - Phone:901-691-6950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251X00000XAgenciesSupports Brokerage
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness