Provider Demographics
NPI:1124640974
Name:LIBERTY FAMILY CARE LLC
Entity type:Organization
Organization Name:LIBERTY FAMILY CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:BOLAJI
Authorized Official - Middle Name:O
Authorized Official - Last Name:OLUGBOJA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:410-301-6767
Mailing Address - Street 1:8515 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4832
Mailing Address - Country:US
Mailing Address - Phone:410-301-6767
Mailing Address - Fax:
Practice Address - Street 1:8515 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4832
Practice Address - Country:US
Practice Address - Phone:410-301-6767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-15
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty