# LIBERTY HEALTHCARE GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mary Gran Nursing Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720033475
- **Authorized official:** MR. JOE CALCUTT (CFO)
- **Authorized official phone:** (910) 332-1793

## Contact information

- **Practice address:** 120 SOUTHWOOD DRIVE, CLINTON, NC 28329
- **Practice address phone:** (910) 592-7981
- **Practice address fax:** (910) 592-3538
- **Mailing address:** 2334 SOUTH 41ST STREET, LIBERTY HEALTHCARE MANAGEMENT, WILMINGTON, NC 28403
- **Mailing address phone:** (910) 332-1777
- **Mailing address fax:** (910) 815-3114

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | NH0089 | NC | — |
| 314000000X | Skilled Nursing Facility | NH0089 | NC | Yes |

## Other

- **Enumeration date:** 05/23/2006
- **Last updated:** 08/10/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3415218 | — | NC |
| 05 | — | 3416093 | — | NC |
| 05 | — | 7803731 | — | NC |