Provider Demographics
NPI:1851002042
Name:LIBERTY BEHAVIORAL & COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:LIBERTY BEHAVIORAL & COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LADALE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-910-0406
Mailing Address - Street 1:5601 W SLAUSON AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6576
Mailing Address - Country:US
Mailing Address - Phone:310-345-6651
Mailing Address - Fax:
Practice Address - Street 1:5601 W SLAUSON AVE STE 130
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6576
Practice Address - Country:US
Practice Address - Phone:310-345-6651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-08
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health