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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