LIBERTY HOME LLC


Address: 9649 N 36th Ave, Phoenix, AZ 85051
Phone: 6024236758

LIBERTY HOME LLC (NPI# 1558832683) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1558832683
Entity Type Organization
Organization Name LIBERTY HOME LLC
Practice Address 9649 N 36th Ave
Phoenix
AZ 85051
Practice Telephone 6024236758
Mailing Telephone 6024236758
Enumeration Date 2018-12-16
Last Update Date 2018-12-16
Authorized Official Name MOHAMED SESAY (PROGRAM DIRECTOR)
Authorized Official Telephone 6024236758
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities Residential Treatment Facilities

Other Provider/Organization Names

Other Name Type Code
Liberty Home LLC Doing Business As Name - Organization

Office Location

Street Address 9649 N 36TH AVE
City PHOENIX
State AZ
Zip Code 85051

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Taxonomy Information

Taxonomy Code 320600000X
Grouping Residential Treatment Facilities
Classification Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities

Taxonomy Definition

A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently.
Notes: [7/1/2003: new]

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1780206466 Solutions Integrated LLC Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 4150 N 12th St, Phoenix, AZ 85014-4994 2020-05-15
1790307486 Smith-zen Home LLC Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 2727 E Camelback Rd Apt 207, Phoenix, AZ 85016-4472 2020-05-15
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City PHOENIX
Zip Code 85051

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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