Organization
LIBERTY CORNER ENTERPRISES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIE CROSSON (BOOKKEEPER)
(828) 254-9917
Entity
Organization
Contact information
Practice address
30 CHURCH ST, CANTON, NC 28716-4432
(828) 400-9184
Mailing address
723 FAIRVIEW RD, ASHEVILLE, NC 28803-1107
(828) 254-9917
(828) 251-5373
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3408614
—
NC
05
—
5950430
—
NC
05
—
7804737
—
NC
05
—
8301154
—
NC
Enumeration date
08/19/2015
Last updated
08/19/2015
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