Provider Demographics
NPI:1104643246
Name:LIBERTY HOUSE
Entity type:Organization
Organization Name:LIBERTY HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:RAMAH
Authorized Official - Middle Name:R
Authorized Official - Last Name:SISTRUNK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-937-2316
Mailing Address - Street 1:1387 GARMAN RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-6454
Mailing Address - Country:US
Mailing Address - Phone:330-937-2316
Mailing Address - Fax:
Practice Address - Street 1:1804 5TH ST SE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44707-3008
Practice Address - Country:US
Practice Address - Phone:330-937-2316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness