Provider Demographics
NPI:1619203502
Name:LIBERTY BEHAVIORAL HEALTH, CORP.
Entity Type:Organization
Organization Name:LIBERTY BEHAVIORAL HEALTH, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CASKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-668-8800
Mailing Address - Street 1:401 E CITY AVE
Mailing Address - Street 2:SUITE 820
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1122
Mailing Address - Country:US
Mailing Address - Phone:610-668-8800
Mailing Address - Fax:
Practice Address - Street 1:1600 HANOVER AVE
Practice Address - Street 2:STEWARD BUILDING
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18109-2408
Practice Address - Country:US
Practice Address - Phone:610-295-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102375037001Medicare PIN