Provider Demographics
NPI:1790821288
Name:LIBERTY CORNER ENTERPRISES, INC
Entity Type:Organization
Organization Name:LIBERTY CORNER ENTERPRISES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRETA
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-254-9917
Mailing Address - Street 1:119 TUNNEL RD STE 120
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-1869
Mailing Address - Country:US
Mailing Address - Phone:828-254-9917
Mailing Address - Fax:828-251-5373
Practice Address - Street 1:119 TUNNEL RD STE 120
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-1869
Practice Address - Country:US
Practice Address - Phone:828-254-9917
Practice Address - Fax:828-251-5373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL011005251B00000X, 251C00000X, 251S00000X, 320600000X, 320900000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408614Medicaid
NC8301154Medicaid
NC5950430Medicaid
NC7804737Medicaid