NPIMap

Organization Active NPI

Liberation Way, LLC

  • Substance Abuse Rehabilitation Facility
  • Bala Cynwyd, PA
National Provider Identifier
1801248919
Registry record updated Jul 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
097105 Issued in PA
Legal business name
LIBERATION WAY, LLC
Practice address
225 E City Ave
Bala Cynwyd, PA 19004-1704
Phone
(877) 636-9322
NPI assigned
Jul 13, 2016
Last updated
Jul 13, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2016

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

Authorized official

Name
Branden Coluccio
Title
Cfo
Phone
(877) 636-9322

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 097105 PA Primary

Addresses

Primary practice location

225 E City Ave
Bala Cynwyd, PA 19004-1704

Mailing address

PO Box 826742
Philadelphia, PA 19182-1704
Phone (877) 636-9322

National Provider Directory

National Provider Directory
Tax ID family
Liberation Way LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1468368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468368000000",
    "number": "1801248919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 826742",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191821704",
            "telephone_number": "877-636-9322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 E CITY AVE",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190041704",
            "telephone_number": "877-636-9322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERATION WAY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-13",
        "last_updated": "2016-07-13",
        "status": "A",
        "authorized_official_last_name": "COLUCCIO",
        "authorized_official_first_name": "BRANDEN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "877-636-9322"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "PA",
            "license": "097105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bala Cynwyd, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 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.