Provider Demographics
NPI:1366696817
Name:LIBERATOR HEALTH AND EDUCATIONAL SERVICES, INC.
Entity type:Organization
Organization Name:LIBERATOR HEALTH AND EDUCATIONAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:LIBRATORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-287-4598
Mailing Address - Street 1:4651 SALISBURY RD
Mailing Address - Street 2:SUITE 471
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6107
Mailing Address - Country:US
Mailing Address - Phone:772-287-4598
Mailing Address - Fax:800-755-0843
Practice Address - Street 1:4651 SALISBURY RD
Practice Address - Street 2:SUITE 471
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-6107
Practice Address - Country:US
Practice Address - Phone:772-287-4598
Practice Address - Fax:800-755-0843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty