NPIMap

Organization Active NPI

Liberty Healthcare Group LLC

Doing business as Mary Gran Nursing Center

  • Assisted Living Facility
  • Clinton, NC
National Provider Identifier
1053454306
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
NH0089 Issued in NC
Legal business name
LIBERTY HEALTHCARE GROUP LLC
Doing business as
Mary Gran Nursing Center
Practice address
120 Southwood Dr
Clinton, NC 28328-5002
Phone
(910) 592-7981
Fax
(910) 592-1864
NPI assigned
Feb 15, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joe Calcutt
Title
Cfo
Phone
(910) 815-1793

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X NH0089 NC Primary

Addresses

Primary practice location

120 Southwood Dr
Clinton, NC 28328-5002

Mailing address

2334 S 41St St
Wilmington, NC 28403-5502
Phone (910) 815-3122

Other identifiers 1

IdentifierTypeStateIssuer
7803731MedicaidNC

Other names 1

  • Mary Gran Nursing Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Liberty Nursing Services LLC119 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 21

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 21

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053454306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2334 S 41ST ST",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284035502",
            "telephone_number": "910-815-3122",
            "fax_number": "910-642-8537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 SOUTHWOOD DR",
            "city": "CLINTON",
            "state": "NC",
            "postal_code": "283285002",
            "telephone_number": "910-592-7981",
            "fax_number": "910-592-1864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY HEALTHCARE GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CALCUTT",
        "authorized_official_first_name": "JOE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "910-815-1793"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NC",
            "license": "NH0089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7803731",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mary Gran Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clinton, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.