Provider Demographics
NPI:1154360055
Name:LIBERTYCARE, INC.
Entity type:Organization
Organization Name:LIBERTYCARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOLA
Authorized Official - Middle Name:B
Authorized Official - Last Name:STEPHEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:281-342-1974
Mailing Address - Street 1:710 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-3405
Mailing Address - Country:US
Mailing Address - Phone:281-342-1974
Mailing Address - Fax:281-342-9912
Practice Address - Street 1:710 S 8TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3405
Practice Address - Country:US
Practice Address - Phone:281-342-1974
Practice Address - Fax:281-342-9912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX003536251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX003536OtherSTATE OF TEXAS LICENSE
TX458461Medicare Oscar/Certification