# LIBERAL MANOR INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619041183
- **Authorized official:** MRS. KATHLEEN BLANCHE DAVIS (ADMINISTRATOR)
- **Authorized official phone:** (313) 874-5404

## Contact information

- **Practice address:** 129 VIRGINIA PARK ST, DETROIT, MI 48202-2000
- **Practice address phone:** (313) 874-5404
- **Practice address fax:** (248) 208-0024
- **Mailing address:** 14981 LIBERAL ST, DETROIT, MI 48205-1905
- **Mailing address phone:** (313) 526-0693
- **Mailing address fax:** (248) 208-0024

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | MI | Yes |

## Other

- **Enumeration date:** 11/17/2006
- **Last updated:** 08/22/2020