Organization
LIBERTY ENTERPRISES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN R. BROWN (ADMINISTRATOR)
(618) 997-9336
Entity
Organization
Contact information
Practice address
1304 W MACK AVE, MARION, IL 62959-4510
(618) 997-9336
Mailing address
1304 W MACK AVE, MARION, IL 62959-4510
(618) 997-9336
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
0037085
IL
Other
Enumeration date
03/23/2007
Last updated
08/22/2020
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