Provider Demographics
NPI:1740799584
Name:LIBERTY RESOURCES HOME CHOICES, LLC
Entity type:Organization
Organization Name:LIBERTY RESOURCES HOME CHOICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FERMINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-634-2000
Mailing Address - Street 1:112 N 8TH ST STE 600
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-2422
Mailing Address - Country:US
Mailing Address - Phone:215-634-2000
Mailing Address - Fax:215-701-8759
Practice Address - Street 1:112 N 8TH ST STE 600
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-2422
Practice Address - Country:US
Practice Address - Phone:215-634-2000
Practice Address - Fax:215-701-8759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA23213601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care