Provider Demographics
NPI:1902004120
Name:LIBERTY CENTRE SERVICES, INC.
Entity Type:Organization
Organization Name:LIBERTY CENTRE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:
Authorized Official - Last Name:SKOKAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-370-3503
Mailing Address - Street 1:900 E NORFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-5502
Mailing Address - Country:US
Mailing Address - Phone:402-370-3503
Mailing Address - Fax:402-370-3250
Practice Address - Street 1:900 E NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-5502
Practice Address - Country:US
Practice Address - Phone:402-370-3503
Practice Address - Fax:402-370-3250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========81Medicaid
NE=========82Medicaid
NE=========80Medicaid