1164854592 NPI number — LIBERTY OXYGEN AND HOME CARE, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164854592 NPI number — LIBERTY OXYGEN AND HOME CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIBERTY OXYGEN AND HOME CARE, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164854592
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4820 PARK GLEN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST LOUIS PARK
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55416-5702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-920-0460
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11650 ROUND LAKE BLVD NW
Provider Second Line Business Practice Location Address:
107
Provider Business Practice Location Address City Name:
COON RAPIDS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55433-2700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-231-2077
Provider Business Practice Location Address Fax Number:
763-231-2177
Provider Enumeration Date:
08/08/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SHEEHY
Authorized Official First Name:
FRANCIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
952-920-0460

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  5677949 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 79B05LI . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1030361 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 170158 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 183427400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 83371 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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