Provider Demographics
NPI:1154787240
Name:LIBERTY HOUSE FOUNDATION, INC.
Entity type:Organization
Organization Name:LIBERTY HOUSE FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:ENSER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MS
Authorized Official - Phone:518-798-1066
Mailing Address - Street 1:54 BAY STREET
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-3028
Mailing Address - Country:US
Mailing Address - Phone:518-798-1066
Mailing Address - Fax:518-798-1166
Practice Address - Street 1:54 BAY STREET
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3028
Practice Address - Country:US
Practice Address - Phone:518-798-1066
Practice Address - Fax:518-798-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health