Provider Demographics
NPI:1245472034
Name:LIBERTY CARE AND INVESTMENT GROUP, INC.
Entity type:Organization
Organization Name:LIBERTY CARE AND INVESTMENT GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:QUINCY
Authorized Official - Middle Name:B
Authorized Official - Last Name:ARAGBAYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-237-7947
Mailing Address - Street 1:922 E. HOLT AVE.
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-5719
Mailing Address - Country:US
Mailing Address - Phone:909-237-7947
Mailing Address - Fax:909-461-6030
Practice Address - Street 1:922 E. HOLT AVE.
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-5719
Practice Address - Country:US
Practice Address - Phone:909-237-7947
Practice Address - Fax:909-461-6030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2011-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50775332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6425780001Medicare NSC