Organization
CLC OF LIBERTY, LLC
Active
Other names
Liberty Community Living Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS M. WRIGHT JR. (MANAGING MEMBER)
(662) 680-3148
Entity
Organization
Contact information
Practice address
323 INDUSTRIAL PARK, LIBERTY, MS 39645-8069
(601) 657-1000
(601) 657-1008
Mailing address
323 INDUSTRIAL PARK, LIBERTY, MS 39645-8069
(601) 657-1000
(601) 657-1008
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
930
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0230121
—
MS
Enumeration date
10/25/2005
Last updated
01/28/2008
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