NPIMap

Liberty Corner Enterprises, Inc.

Organization Active NPI Community/Behavioral Health Agency · Waynesville, NC

NPI 1548645385 · NPPES record last updated Feb 4, 2021

Key facts

NPI
1548645385
Entity type
Organization (NPI type 2)
Primary specialty
Community/Behavioral Health Agency 251S00000X
Legal business name
LIBERTY CORNER ENTERPRISES, INC.
Practice address
35 Aquifer Brae LN
Waynesville, NC 28786-0169
Phone
(828) 456-7510
NPI assigned
Jul 22, 2015
Organization subpart
No

Authorized official

Name
Mrs. Greta Byrd, MBA
Title
Executive Director
Phone
(828) 254-9917

Corporate family (same tax ID) 10

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Liberty Corner Enterprises Inc (11 organizations share this tax ID)

Locations

35 Aquifer Brae Ln
Waynesville, NC 28786
Phone (828) 456-7510

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Developmentally Disabled Services Day Training Agency 251C00000X
Community/Behavioral Health Agency 251S00000X Yes
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

35 Aquifer Brae LN
Waynesville, NC 28786-0169

Mailing address

119 Tunnel Rd. Suite 120a
Asheville, NC 28805-1107
Phone (828) 254-9917

Other identifiers

IdentifierTypeStateIssuer
3408614MedicaidNC
5950430MedicaidNC
8300154MedicaidNC
7804737MedicaidNC

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 4, 2021.

{
    "created_epoch": "1437523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612396800000",
    "number": "1548645385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 TUNNEL RD. SUITE 120A",
            "city": "ASHEVILLE",
            "state": "NC",
            "postal_code": "288051107",
            "telephone_number": "828-254-9917",
            "fax_number": "828-251-5373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 AQUIFER BRAE LN",
            "city": "WAYNESVILLE",
            "state": "NC",
            "postal_code": "287860169",
            "telephone_number": "828-456-7510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY CORNER ENTERPRISES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-22",
        "last_updated": "2021-02-04",
        "certification_date": "2021-02-04",
        "status": "A",
        "authorized_official_last_name": "BYRD",
        "authorized_official_first_name": "GRETA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "828-254-9917",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3408614",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5950430",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300154",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7804737",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waynesville, NC

All providers in Waynesville, NC · Community/Behavioral Health Agency in North Carolina

Sources for this page

Verify at the official NPI Registry.