Active NPI
Liberty Family Care LLC
- Psychiatric/Mental Health Nurse Practitioner
- Randallstown, MD
National Provider Identifier
1154098077
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- Legal business name
- LIBERTY FAMILY CARE LLC
- Practice address
- 8515 Liberty Rd Ste B
Randallstown, MD 21133-4832 - Phone
- (410) 301-6767
- Fax
- (410) 496-3121
- NPI assigned
- Aug 27, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Bolaji Olugboja, CRNP
- Title
- Owner
- 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) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | Primary | ||
| Primary Care Nurse Practitioner | 363LP2300X |
Addresses
Primary practice location
8515 Liberty Rd Ste B
Randallstown, MD 21133-4832
Mailing address
8515 Liberty Rd Ste B
Randallstown, MD 21133-4832
Phone (410) 301-6767
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| R210237 | Other | MD | LICENSE |
National Provider Directory
National Provider DirectoryLocations
8515B Liberty Rd
Randallstown, MD 21133
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Psychiatric/Mental Health Nurse Practitioner
- Randallstown, MD
- NPI 1689005043
-
- Psychiatric/Mental Health Nurse Practitioner
- Silver Spring, MD
- NPI 1407439409
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1630022400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1640044800000",
"number": "1154098077",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8515 LIBERTY RD STE B",
"city": "RANDALLSTOWN",
"state": "MD",
"postal_code": "211334832",
"telephone_number": "410-301-6767",
"fax_number": "410-496-3121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8515 LIBERTY RD STE B",
"city": "RANDALLSTOWN",
"state": "MD",
"postal_code": "211334832",
"telephone_number": "410-301-6767",
"fax_number": "410-496-3121"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LIBERTY FAMILY CARE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2021-08-27",
"last_updated": "2021-12-21",
"certification_date": "2021-09-08",
"status": "A",
"authorized_official_last_name": "OLUGBOJA",
"authorized_official_first_name": "BOLAJI",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "410-301-6767",
"authorized_official_credential": "CRNP"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": null,
"license": null,
"primary": true
},
{
"code": "363LP2300X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner, Primary Care",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "R210237",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}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.