Provider Demographics
NPI:1831387711
Name:LIBERTY LIVING, INC
Entity type:Organization
Organization Name:LIBERTY LIVING, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:RASH
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:704-922-9130
Mailing Address - Street 1:142 DOWNEY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:NC
Mailing Address - Zip Code:28034-9395
Mailing Address - Country:US
Mailing Address - Phone:704-922-9130
Mailing Address - Fax:704-922-7337
Practice Address - Street 1:142 DOWNEY LAKE RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:NC
Practice Address - Zip Code:28034-9395
Practice Address - Country:US
Practice Address - Phone:704-922-9130
Practice Address - Fax:704-922-7337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services