CLC OF LIBERTY, LLC (NPI# 1912997685) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912997685 |
| Entity Type | Organization |
| Organization Name | CLC OF LIBERTY, LLC |
| Other Organization Name | LIBERTY COMMUNITY LIVING CENTER |
| Practice Address |
323 Industrial Park Liberty MS 39645-8069 |
| Practice Telephone | 6016571000 |
| Practice Fax Number | 6016571008 |
| Mailing Telephone | 6016571000 |
| Mailing Fax Number | 6016571008 |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2008-01-28 |
| Authorized Official Name | MR. DOUGLAS M. WRIGHT JR. (MANAGING MEMBER) |
| Authorized Official Telephone | 6626803148 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | 930 | MS | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 0230121 | 05 |
| Other Name | Type Code |
|---|---|
| Liberty Community Living Center | Doing Business As Name - Organization |
| Street Address |
323 INDUSTRIAL PARK |
| City | LIBERTY |
| State | MS |
| Zip Code | 39645-8069 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124317060 | Paragon Rehab, LLC | Occupational Therapist | 323 Industrial Park, Liberty, MS 39645-8069 | 2011-03-31 |
| 1790074631 | Paragon Rehab, LLC | Physical Therapy Assistant | 323 Industrial Park, Liberty, MS 39645-8069 | 2011-03-31 |
| 1083913651 | Melissa Glass | Occupational Therapist | 323 Industrial Park, Liberty, MS 39645-8069 | 2011-03-22 |
| 1306145958 | Paragon Rehab, LLC | Physical Therapist | 323 Industrial Park, Liberty, MS 39645-8069 | 2011-03-22 |
| 1184923757 | Caroline Mckowen | Speech-Language Pathologist | 323 Industrial Park, Liberty, MS 39645-8069 | 2011-03-22 |
| 1285933853 | Darcy Mccoy | Physical Therapist | 323 Industrial Park, Liberty, MS 39645-8069 | 2011-03-22 |
| 1255668042 | Elissa Jones | Physical Therapist | 323 Industrial Park, Liberty, MS 39645-8069 | 2009-11-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558962563 | Cassycel Thigpen | Psychologist | 4894a Highway 584 Liberty, 4894a Highway 584 Liberty, Liberty, MS 39645 | 2020-11-05 |
| 1730566175 | John Mason Douglas | Nurse Practitioner | 102 W Freedom Dr, Liberty, MS 39645 | 2015-05-06 |
| 1407101140 | Weathers Chiropractic Center Pllc | Chiropractor | 128 West Broken St, Liberty, MS 39645 | 2012-07-18 |
| 1265646145 | Amite County School District | Registered Nurse | 3457 S. Greensburg Rd., Liberty, MS 39645 | 2007-05-09 |
| 1861428716 | Heather Johnson Harden | Nurse Practitioner | 138 Clinic Drive, Liberty, MS 39645 | 2006-06-23 |
| 1427567791 | Melanie Dawne Robertson | Nurse Practitioner | 102 W Freedom Dr, Liberty, MS 39645 | 2017-09-29 |
| 1295097269 | Karen Christine Ross | Nurse Practitioner | 102 West Freedom Drive, Liberty, MS 39645 | 2012-06-14 |
| 1528337367 | Care One Health | In Home Supportive Care | 171 East Main Street, Liberty, MS 39645 | 2011-12-23 |
| 1659693083 | Amite County Medical Services, Inc. | Clinic/Center | 102 West Freedom Drive, Liberty, MS 39645 | 2010-02-26 |
| 1639124183 | Liberty Drug Store, Inc. | Pharmacist | 110 E Main St, Liberty, MS 39645 | 2006-05-23 |
| Find all providers in zip 39645 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598288755 | Lhlc Operations, LLC | Skilled Nursing Facility | 2609 Glenn Hendren Dr Ste G100, Liberty, MO 64068 | 2017-07-19 |
| 1144769563 | Liberty County Hospital District No. 1 | Skilled Nursing Facility | 624 Fannin St, Liberty, TX 77575-4916 | 2017-02-17 |
| 1699922559 | Ronda May | Skilled Nursing Facility | 228 Casey Dr, Liberty, KY 42539-3229 | 2008-08-22 |
| 1558518506 | Sherry Wesley IIi | Skilled Nursing Facility | 2757 Canoe Creek Rd, Liberty, KY 42539-6127 | 2008-08-21 |
| 1982866802 | Jan-doreen Williamson | Skilled Nursing Facility | 616 S Wallace Wilkinson Blvd, Liberty, KY 42539-3344 | 2008-07-01 |
| 1295830776 | Pleasant Valley Manor Inc | Skilled Nursing Facility | 6814 Sobbie Road, Liberty, MO 64068 | 2006-09-13 |
| 1548362395 | Hsmtx/liberty, LLC | Skilled Nursing Facility | 1206 N Travis St, Liberty, TX 77575 | 2006-09-02 |
| 1699722876 | Ashton Court Healthcare LLC | Skilled Nursing Facility | 1200 W College St, Liberty, MO 64068-1036 | 2006-05-31 |
| 1861458036 | Wmop LLC | Skilled Nursing Facility | 170 Lake St, Liberty, NY 12754-1966 | 2006-04-25 |
| 1437151420 | Liberty Terrace Nursing LLC | Skilled Nursing Facility | 2201 Glenn Hendren Dr, Liberty, MO 64068-3375 | 2005-08-10 |
| Find all providers in LIBERTY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.