Provider Demographics
NPI:1235974288
Name:LIBERTY HOME CARE NURSING AGENCY LLC
Entity type:Organization
Organization Name:LIBERTY HOME CARE NURSING AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-750-3844
Mailing Address - Street 1:10510 GROVE RIDGE PL
Mailing Address - Street 2:
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4656
Mailing Address - Country:US
Mailing Address - Phone:512-750-3844
Mailing Address - Fax:
Practice Address - Street 1:1101 CONNECTICUT AVE NW STE 450
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-4359
Practice Address - Country:US
Practice Address - Phone:202-883-6495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health