Organization
DME HEALTH MANAGEMENT GROUP LLC
Active
Other names
Liberty Care Services
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK MORENO (MAJORITY MEMBER)
(208) 734-7730
Entity
Organization
Contact information
Practice address
460 MAIN AVE SOUTH, SUITE C, TWIN FALLS, ID 83301
(208) 734-7730
(208) 735-8176
Mailing address
P.O. BOX 1641, 460 MAIN AVE. SOUTH SUITE C, TWIN FALLS, ID 83301
(208) 734-7730
(208) 735-8176
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806769900
—
ID
05
—
806815900
—
ID
05
—
806857800
—
ID
05
—
806875000
—
ID
Enumeration date
01/05/2007
Last updated
09/16/2008
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