Provider Demographics
NPI:1447067186
Name:AT LIBERTY PLACE LLC,
Entity type:Organization
Organization Name:AT LIBERTY PLACE LLC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:REMENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEARS-CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-294-7979
Mailing Address - Street 1:1655 SWEDESBORO AVE
Mailing Address - Street 2:
Mailing Address - City:PAULSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08066-1533
Mailing Address - Country:US
Mailing Address - Phone:856-294-7979
Mailing Address - Fax:
Practice Address - Street 1:1655 SWEDESBORO AVE
Practice Address - Street 2:
Practice Address - City:PAULSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08066-1533
Practice Address - Country:US
Practice Address - Phone:856-294-7979
Practice Address - Fax:856-599-1379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home