Basic Information
| Provider Information | |||||||||
| NPI: | 1184161382 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LIBERTY HOME HEALTH SERVICES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4336 W FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | BELLBROOK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453051551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372961550 | ||||||||
| FaxNumber: | 9372961540 | ||||||||
| Practice Location | |||||||||
| Address1: | 2440 BATON ROUGE | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458055104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192047730 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2017 | ||||||||
| LastUpdateDate: | 01/25/2017 | ||||||||
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| AuthorizedOfficialLastName: | BLACK-KUREK | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9372961550 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
No ID Information.