Provider Demographics
NPI:1518382274
Name:LIBERATION, LLC
Entity type:Organization
Organization Name:LIBERATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADELAYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-708-9014
Mailing Address - Street 1:802 N 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003-1316
Mailing Address - Country:US
Mailing Address - Phone:602-559-4922
Mailing Address - Fax:888-349-1581
Practice Address - Street 1:802 N. 5TH
Practice Address - Street 2:
Practice Address - City:PNOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-1316
Practice Address - Country:US
Practice Address - Phone:602-708-9014
Practice Address - Fax:888-349-1581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC5977261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty