Liberty Commons of Cheraw, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

LIBERTY COMMONS OF CHERAW, LLC

Practice address

400 Moffat Road
Cheraw, SC 29520

Phone

(843) 537-5253

NPI assigned

Feb 17, 2023

Organization subpart

No

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

Authorized official

Name

Jeffrey Wilson

Title

Chief Operating Officer

Phone

(910) 815-3122

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Cheraw Healthcare Doing business as

Electronic endpoints 1

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

{
    "created_epoch": "1676592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676592000000",
    "number": "1982302121",
    "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": "400 MOFFAT ROAD",
            "city": "CHERAW",
            "state": "SC",
            "postal_code": "29520",
            "telephone_number": "843-537-5253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY COMMONS OF CHERAW, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-17",
        "last_updated": "2023-02-17",
        "certification_date": "2023-02-13",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "910-815-3122"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE OSCAR / CERTIFICATION",
            "identifier": "425005",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Other",
            "affiliation": "N",
            "endpointDescription": "Skilled Nursing Facility",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Other",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Skilled Nursing Facility",
            "address_1": "400 Moffat Road",
            "city": "Cheraw",
            "state": "SC",
            "country_code": "US",
            "postal_code": "29520",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Cheraw Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Darran Mahendra Khublall, MD
• Cody Lee Kidd, DO
• Roachel William Laney, D.M.D
• Ryan Lapointe
• Carl S T Li, MD
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• Agostina Liotta
• Brittney Inci Little
• Camillia L Livingston, RN

• Skilled Nursing Facility in Cheraw, SC
• Providers in Cheraw, SC by specialty
• Skilled Nursing Facility in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2023; 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.