Provider Demographics
NPI:1851016687
Name:LIBERTY HOMES OHIO
Entity Type:Organization
Organization Name:LIBERTY HOMES OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DURRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:WAJI
Authorized Official - Suffix:
Authorized Official - Credentials:MR
Authorized Official - Phone:614-218-8070
Mailing Address - Street 1:4758 ECHOROCK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-5957
Mailing Address - Country:US
Mailing Address - Phone:614-218-8070
Mailing Address - Fax:
Practice Address - Street 1:4758 ECHOROCK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-5957
Practice Address - Country:US
Practice Address - Phone:614-218-8070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282J00000XHospitalsReligious Nonmedical Health Care Institution