Organization
CAREGIVERS OF LIBERTY I
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KANDICE LACKEY JENKINS (OWNER)
(336) 622-0088
Entity
Organization
Contact information
Practice address
121 EAST RALEIGH AVE, LIBERTY, NC 27298-3005
(336) 622-0088
Mailing address
121 EAST RALEIGH AVE, LIBERTY, NC 27298-3005
(336) 622-0088
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
FCL076028
NC
311ZA0620X
Adult Care Home Facility
FCL-076-028
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7804675
PROVIDER NUMBER
NC
05
—
7804675
—
NC
Enumeration date
03/01/2007
Last updated
07/14/2008
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