Liberty RC Inc

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

LIBERTY RC INC

Doing business as

Mount Hope Dialysis

Practice address

1940 Webster Ave
FL 2, Ste 200
Bronx, NY 10457-4261

Phone

(718) 901-9122

Fax

(718) 901-9116

NPI assigned

Jun 21, 2016

Last updated

Mar 4, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Samuel Wey

Title

VP Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mount Hope Dialysis Doing business as

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

{
    "created_epoch": "1466467200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709510400000",
    "number": "1326498205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L & C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569",
            "telephone_number": "615-341-6410",
            "fax_number": "888-662-8259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1940 WEBSTER AVE",
            "address_2": "FL 2, STE 200",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104574261",
            "telephone_number": "718-901-9122",
            "fax_number": "718-901-9116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY RC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-21",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-04",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "VP LICENSURE & CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05713153",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mount Hope Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Charles Edmond Libby, MD
• Olivia Liberatore
• Rasheena Monique Libert'E
• Liberty RC Inc (Eastchester Road Dialysis Center)
• Liberty RC Inc (Bedford Park Dialysis Center)
• Liberty Rhea Ranada Ebarle PT PC
• Atara Libman, MS, OTR/L
• Anastasia Libovich, LM
• Libra Suites
• Jae Libradilla, PT

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Bronx, NY
• Providers in Bronx, NY by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2024; 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.