Provider Demographics
NPI:1760437123
Name:LIBERTY HEALTHCARE GROUP, LLC
Entity Type:Organization
Organization Name:LIBERTY HEALTHCARE GROUP, LLC
Other - Org Name:LIBERTY HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF HOME CARE ANDHOSPICE
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:TURLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:919-770-4551
Mailing Address - Street 1:2334 S 41ST ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-5502
Mailing Address - Country:US
Mailing Address - Phone:910-815-3122
Mailing Address - Fax:910-815-3111
Practice Address - Street 1:1019 HIGHWAY 17 S UNIT 124
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3702
Practice Address - Country:US
Practice Address - Phone:843-839-2273
Practice Address - Fax:843-839-2277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHHA163251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC007AOtherBLUE CROSS BLUE SHIELD
SCHHA163Medicaid
SC007AOtherBLUE CROSS BLUE SHIELD