Provider Demographics
NPI:1770765224
Name:LIBERTE HEALTHCARE PERSONNEL
Entity type:Organization
Organization Name:LIBERTE HEALTHCARE PERSONNEL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:S
Authorized Official - Last Name:LALIBERTE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:623-332-7628
Mailing Address - Street 1:1267 S 226TH DR
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-8917
Mailing Address - Country:US
Mailing Address - Phone:623-332-7628
Mailing Address - Fax:623-327-2187
Practice Address - Street 1:1267 S 226TH DR
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-8917
Practice Address - Country:US
Practice Address - Phone:623-332-7628
Practice Address - Fax:623-327-2187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN128301251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care