Provider Demographics
NPI:1851662993
Name:LIBERTY HEALTHCARE SERVISES INC.
Entity Type:Organization
Organization Name:LIBERTY HEALTHCARE SERVISES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EUCHARIA
Authorized Official - Middle Name:IFEOMA
Authorized Official - Last Name:DURU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-630-5721
Mailing Address - Street 1:6281 VININGS VINTAGE DR
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-7202
Mailing Address - Country:US
Mailing Address - Phone:770-630-5721
Mailing Address - Fax:770-485-7340
Practice Address - Street 1:6281 VININGS VINTAGE DR
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-7202
Practice Address - Country:US
Practice Address - Phone:770-630-5721
Practice Address - Fax:770-485-7340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033-R-0804251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care