Provider Demographics
NPI:1629373634
Name:LIBERTY CARE, LLC
Entity Type:Organization
Organization Name:LIBERTY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOLLUM
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:951-280-3001
Mailing Address - Street 1:3045 S ARCHIBALD AVE STE H
Mailing Address - Street 2:SUITE 299
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-9001
Mailing Address - Country:US
Mailing Address - Phone:951-280-3001
Mailing Address - Fax:951-280-3002
Practice Address - Street 1:6245 MULAN ST
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92880-0793
Practice Address - Country:US
Practice Address - Phone:951-280-3001
Practice Address - Fax:951-280-3002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-22
Last Update Date:2011-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201016110114343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)