NPIMap

Organization Active NPI

Liberty Family Care LLC

  • Primary Care Nurse Practitioner
  • Randallstown, MD
National Provider Identifier
1124640974
Registry record updated Dec 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
LIBERTY FAMILY CARE LLC
Practice address
8515 Liberty Rd
Randallstown, MD 21133-4832
Phone
(410) 301-6767
NPI assigned
May 15, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2021

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

Authorized official

Name
Dr. Bolaji O Olugboja, DNPNPI 1689005043
Title
Dr.
Phone
(410) 301-6767

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LP0808X
Primary Care Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LP2300X Primary

Addresses

Primary practice location

8515 Liberty Rd
Randallstown, MD 21133-4832

Mailing address

8515 Liberty Rd
Randallstown, MD 21133-4832
Phone (410) 301-6767

Other names 1

  • Liberty Family Care Other name

National Provider Directory

National Provider Directory

Locations

8515 Liberty Rd
Randallstown, MD 21133
Phone (410) 301-6767

8515 Liberty Rd
#B
Randallstown, MD 21133
Phone (410) 301-6767

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1589500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640044800000",
    "number": "1124640974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8515 LIBERTY RD",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211334832",
            "telephone_number": "410-301-6767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8515 LIBERTY RD",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211334832",
            "telephone_number": "410-301-6767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY FAMILY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-15",
        "last_updated": "2021-12-21",
        "certification_date": "2021-09-08",
        "status": "A",
        "authorized_official_last_name": "OLUGBOJA",
        "authorized_official_first_name": "BOLAJI",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "DR.",
        "authorized_official_telephone_number": "410-301-6767",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Liberty Family Care",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Randallstown, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; 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.