LIBERAL MANOR INC (NPI# 1619041183) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619041183 |
| Entity Type | Organization |
| Organization Name | LIBERAL MANOR INC |
| Practice Address |
129 Virginia Park St Detroit MI 48202-2000 |
| Mailing Address |
14981 Liberal St Detroit MI 48205-1905 |
| Practice Telephone | 3138745404 |
| Practice Fax Number | 2482080024 |
| Mailing Telephone | 3135260693 |
| Mailing Fax Number | 2482080024 |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MRS. KATHLEEN BLANCHE DAVIS (ADMINISTRATOR) |
| Authorized Official Telephone | 3138745404 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | MI | Residential Treatment Facilities |
| Street Address |
129 VIRGINIA PARK ST |
| City | DETROIT |
| State | MI |
| Zip Code | 48202-2000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710584602 | Andrea Irene Martin | Audiologist | 2799 E Grand Blvd, Detroit, MI 48202 | 2020-10-05 |
| 1174132583 | Odei Alayyas | Student in an Organized Health Care Education/Training Program | 2799 W. Grand Boulevard Henry Ford Hospital, Medical Ed, Detroit, MI 48202 | 2020-07-31 |
| 1912529801 | Aroob Nabil Nimer Sweidan | Student in an Organized Health Care Education/Training Program | 2799 West Grand Boulvard, Department of Internal Meidicine, Cfp 1, Detroit, MI 48202 | 2020-05-13 |
| 1306485636 | Katie Burlen-davis | Registered Nurse | 9045 Woodward Ave, Detroit, MI 48202 | 2020-01-03 |
| 1407401250 | Santhalakshmi Angappan | Student in an Organized Health Care Education/Training Program | Henry Ford Hospital Medical Education Department, 2799 W. Grand Boulevard, Detroit, MI 48202 | 2019-08-08 |
| 1851945687 | Walter Mitini Etoh | Nurse Practitioner | Henry Ford Hospital I1 Observation, 2799 W. Grand Blvd, Detroit, MI 48202 | 2019-07-30 |
| 1467913756 | Andrew Michael Schock | Emergency Medicine | Ceci Murrell-harvey, Henry Ford Hospital, 2799 W. Grand. Blvd, Cfp 046, Detroit, MI 48202 | 2019-03-28 |
| 1700363892 | Zaid Al-saheli | Student in an Organized Health Care Education/Training Program | 2799 W. Grand Blvdl, Cfp 046, Hope Peck, Detroit, MI 48202 | 2018-07-23 |
| 1932690096 | Yusuf Naser Alalwan | Student in an Organized Health Care Education/Training Program | 2799 W. Grand Blvd. Henry Ford Hospital - Gme Office, Detroit, MI 48202 | 2018-05-24 |
| 1568952729 | Kelvin Sellers | Massage Therapist | 832 Seward, Detriot, MI 48202 | 2018-05-14 |
| Find all providers in zip 48202 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| 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] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558984377 | Angel Patient Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 12601 E Outer Dr, Detroit, MI 48224-4204 | 2020-05-27 |
| 1518428333 | Alternative Adult Residence LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 19163 Woodingham Dr, Detroit, MI 48221-1650 | 2019-03-26 |
| 1912481235 | Adrienne Flowers | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 18403 Kentucky St, Detroit, MI 48221-2029 | 2018-09-21 |
| 1558876904 | Bowers Adult Foster Care Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 556 Mount Vernon St, Detroit, MI 48202-2524 | 2017-12-07 |
| 1043622970 | Serenity Facility LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 18514 Blackmoor St, Detroit, MI 48234-3887 | 2014-05-27 |
| 1831411537 | Christ Child Society of Detroit | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 15751 Joy Rd, Detroit, MI 48228-2117 | 2010-02-22 |
| 1790018489 | Derrick Community Development & Human Services | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 5010 31st St, Detroit, MI 48210-2537 | 2009-09-12 |
| 1730319138 | Robinham Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 803 E Grand Blvd, Detroit, MI 48207-2551 | 2009-07-20 |
| 1730256496 | Cyprian Center Inc. | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 4901 Chrysler Dr, Detroit, MI 48201-1462 | 2006-11-29 |
| 1891872792 | Wimby Inc | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 6045 Kensington Ave, Detroit, MI 48224-2072 | 2006-11-01 |
| Find all providers in DETROIT | ||||
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| 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.