Provider Demographics
NPI:1104075738
Name:LIBERTY HEALTHCARE INC
Entity type:Organization
Organization Name:LIBERTY HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:AKINOLA
Authorized Official - Last Name:SALAKO
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:214-650-8283
Mailing Address - Street 1:1009 TRAILWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-5555
Mailing Address - Country:US
Mailing Address - Phone:214-650-8283
Mailing Address - Fax:972-217-1155
Practice Address - Street 1:1009 TRAILWOOD DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-5555
Practice Address - Country:US
Practice Address - Phone:214-650-8283
Practice Address - Fax:972-217-1155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health