Liberty Healthcare Group, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

LIBERTY HEALTHCARE GROUP, LLC

Doing business as

Southport Nursing Center

Practice address

924 N Howe St
Southport, NC 28461-3038

Phone

(910) 457-3800

Fax

(910) 454-4628

NPI assigned

May 26, 2016

Last updated

Sep 29, 2016By the provider in NPPES

Organization subpart

Yes

Parent organization

LIBERTY HEALTHCARE GROUP, LLCAs reported in NPPES

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

Authorized official

Name

Joe V Calcutt

Title

Cfo

Phone

(910) 815-3122

Specialties & licenses 1

Addresses

Other names 1

• Southport Nursing Center Doing business as

Part of

Liberty Nursing Services LLC

Locations

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

{
    "created_epoch": "1464220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475107200000",
    "number": "1457709891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 MCNEILL PLZ",
            "city": "WHITEVILLE",
            "state": "NC",
            "postal_code": "284728602",
            "telephone_number": "910-642-0224",
            "fax_number": "910-642-8537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "924 N HOWE ST",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284613038",
            "telephone_number": "910-457-3800",
            "fax_number": "910-454-4628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY HEALTHCARE GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIBERTY HEALTHCARE GROUP, LLC",
        "enumeration_date": "2016-05-26",
        "last_updated": "2016-09-29",
        "status": "A",
        "authorized_official_last_name": "CALCUTT",
        "authorized_official_first_name": "JOE",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "910-815-3122"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southport Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Wendy Leo
• Leonard David Williams IV DDS-PC (Southport Dental)
• Eric Jon Lescault, DO
• Amanda Lewis
• Liberty Healthcare Group LLC (Liberty Commons Nursing & Rehabilitation Center of Southport, LLC)
• Debora Pyne Lipsen, P.T.
• Dora Connelly Loflin, FNP
• Dennis Long
• LTK LLC (101 Mobility)
• Matthew Justin Lucas, NP-C, DNP

• Skilled Nursing Facility in Southport, NC
• Providers in Southport, NC by specialty
• Skilled Nursing Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2016; 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.