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Organization
LIBERTY HEALTHCARE GROUP LLC
Active
Organization
LIBERTY HEALTHCARE GROUP LLC
Active
Other names
Mary Gran Nursing Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOE CALCUTT (CFO)
(910) 332-1793
Entity
Organization
Contact information
Practice address
120 SOUTHWOOD DRIVE, CLINTON, NC 28329
(910) 592-7981
(910) 592-3538
Mailing address
2334 SOUTH 41ST STREET, LIBERTY HEALTHCARE MANAGEMENT, WILMINGTON, NC 28403
(910) 332-1777
(910) 815-3114
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
NH0089
NC
314000000X
Skilled Nursing Facility
Primary
NH0089
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3415218
—
NC
05
—
3416093
—
NC
05
—
7803731
—
NC
Enumeration date
05/23/2006
Last updated
08/10/2021
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