1619145943 NPI number — LIBERTY OXYGEN AND HOME CARE, INC

Table of content: (NPI 1619145943)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619145943 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:
1619145943
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:
952-920-0480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16322 COUNTY ROAD 30
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAPLE GROVE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55311-1207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-494-4966
Provider Business Practice Location Address Fax Number:
763-494-4977
Provider Enumeration Date:
02/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SHEEHY
Authorized Official First Name:
FRANCIS
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT / OWNER
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: 183427400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • 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: 83371 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 79B05LI . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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