NPIMap

Organization Active NPI

Liberty Healthcare Group LLC

Doing business as Liberty Home Care II, LLC

  • Community Based Hospice Care Agency
  • Smithfield, NC
National Provider Identifier
1124104757
Registry record updated May 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
HOS3069 Issued in NC
Legal business name
LIBERTY HEALTHCARE GROUP LLC
Doing business as
Liberty Home Care II, LLC
Practice address
1317 N Brightleaf Blvd Ste C
Smithfield, NC 27577-7267
Phone
(919) 989-6792
Fax
(919) 989-8519
NPI assigned
Oct 27, 2006
Last updated
May 5, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2010

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

Authorized official

Name
Mr. Anthony J. Zizzamia Jr., RN
Title
President/Executive Director
Phone
(910) 815-3122

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X HOS3069 NC Primary

Addresses

Primary practice location

1317 N Brightleaf Blvd Ste C
Smithfield, NC 27577-7267

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
3421537MedicaidNC
007CHOtherNCBLUE CROSS BLUE SHIELD

Other names 1

  • Liberty Home Care II, LLC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060109000376 NC Part A Provider - Hospice 4587574355 7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wadesboro, NC; Thomasville, NC; Southern Pines, NC; Siler City, NC; Sanford, NC; Raeford, NC; Dunn, NC; Smithfield, NC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124104757. Details of each certification follow.

Hospice certification: CCN 341537

Legal name
LIBERTY HEALTHCARE GROUP LLC
Doing business as
LIBERTY HOME CARE II, LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Nov 29, 1988
Last certification
Jun 16, 2022
Ownership / control type
Proprietary - Corporation
Organization structure
LLCProprietary
Incorporated
Jun 7, 2002 in NC
Enrollment address
336 S Main St
Raeford, NC 28376-3221

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospice

Medicare Care Compare
Listed as
Liberty Home Care II, LLCCCN 341537 · All quality measures
Ownership
For-Profit
Certified
Nov 29, 1988
Medicare certification status
ActiveFrom the Provider of Services file

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 24

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

View all 24

Locations

1317 N Brightleaf Blvd
Ste C
Smithfield, NC 27577
Phone (919) 989-0792

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kimmie Fox Individual Operational/Managerial ControlOperations Manager Jun 22, 2014
Katherine Castello Individual Operational/Managerial Control Jan 29, 2024
Holly Macdonald Individual W-2 Managing EmployeePresident Jul 1, 2019
Barbara Ring Individual Operational/Managerial ControlAdministrator Apr 1, 2018
Brandy Harris Individual Operational/Managerial ControlHospice Administrator Jul 25, 2021
Donna Turlington Individual W-2 Managing EmployeePresident of Home Care and Ho Aug 1, 2023
Ronald Benjamin McNeill Individual 5% Or Greater Direct Ownership Interest Jul 1, 2002
Corporate Director Jan 9, 2006
W-2 Managing Employee Jul 1, 2002
Cheryl Dooley Individual Operational/Managerial ControlOperations Manager Jun 5, 2017

Practitioners & affiliated clinicians

Affiliated clinicians 35

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273017600000",
    "number": "1124104757",
    "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": "910-815-3111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1317 N BRIGHTLEAF BLVD STE C",
            "city": "SMITHFIELD",
            "state": "NC",
            "postal_code": "275777267",
            "telephone_number": "919-989-6792",
            "fax_number": "919-989-8519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY HEALTHCARE GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-27",
        "last_updated": "2010-05-05",
        "status": "A",
        "authorized_official_last_name": "ZIZZAMIA",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT/EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "910-815-3122",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NC",
            "license": "HOS3069",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3421537",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "007CH",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Liberty Home Care II, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Smithfield, NC

Sources for this page

Verify at the official NPI Registry.