Liberal Manor Inc

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

LIBERAL MANOR INC

Practice address

129 Virginia Park St
Detroit, MI 48202-2000

Phone

(313) 874-5404

Fax

(248) 208-0024

NPI assigned

Nov 17, 2006

Last updated

Aug 22, 2020By 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

Mrs. Kathleen Blanche Davis

Title

Administrator

Phone

(313) 874-5404

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1619041183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14981 LIBERAL ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482051905",
            "telephone_number": "313-526-0693",
            "fax_number": "248-208-0024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 VIRGINIA PARK ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022000",
            "telephone_number": "313-874-5404",
            "fax_number": "248-208-0024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERAL MANOR INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "BLANCHE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "313-874-5404",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• David Liao Jr.
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• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Detroit, MI
• Providers in Detroit, MI by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.