1265569032 NPI number — LIBERTY NURSING SERVICES II, LLC

Table of content: (NPI 1265569032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265569032 NPI number — LIBERTY NURSING SERVICES II, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIBERTY NURSING SERVICES II, LLC
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:
1265569032
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2334 S 41ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28403-5502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-815-3122
Provider Business Mailing Address Fax Number:
910-815-3111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 SHAMROCK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28215-3218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-940-8367
Provider Business Practice Location Address Fax Number:
704-940-7458
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCNEILL
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
B
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
910-815-3122

Provider Taxonomy Codes

  • Taxonomy code: 251J00000X , with the licence number:  HC2363 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3409518 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6600974 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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