Provider Demographics
NPI:1245479690
Name:LIBERTY HEALTH CARE, INC
Entity type:Organization
Organization Name:LIBERTY HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AAMFOULTH
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-670-5614
Mailing Address - Street 1:4106 71ST AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-1305
Mailing Address - Country:US
Mailing Address - Phone:763-670-5614
Mailing Address - Fax:763-503-4824
Practice Address - Street 1:4106 71ST AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-1305
Practice Address - Country:US
Practice Address - Phone:763-670-5614
Practice Address - Fax:763-503-4824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN342610251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA642680000OtherUMPI