Provider Demographics
NPI:1861379471
Name:LYBERTY75 HOMECARE
Entity type:Organization
Organization Name:LYBERTY75 HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JIHANATH
Authorized Official - Middle Name:DANIELLA
Authorized Official - Last Name:SOUMANOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-744-5422
Mailing Address - Street 1:9025 LAMON AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1759
Mailing Address - Country:US
Mailing Address - Phone:773-603-0489
Mailing Address - Fax:
Practice Address - Street 1:9025 LAMON AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1759
Practice Address - Country:US
Practice Address - Phone:773-603-0489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care