1245472034 NPI number — LIBERTY CARE AND INVESTMENT GROUP, 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 1245472034 NPI number — LIBERTY CARE AND INVESTMENT GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIBERTY CARE AND INVESTMENT GROUP, 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:
1245472034
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
922 E. HOLT AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POMONA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91767-5719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-237-7947
Provider Business Mailing Address Fax Number:
909-461-6030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
922 E. HOLT AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POMONA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91767-5719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-237-7947
Provider Business Practice Location Address Fax Number:
909-461-6030
Provider Enumeration Date:
03/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ARAGBAYE
Authorized Official First Name:
QUINCY
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
909-237-7947

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  50775 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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