Provider Demographics
NPI:1679756589
Name:LIBERTY NURSING CENTER OF THREE RIVERS INC
Entity type:Organization
Organization Name:LIBERTY NURSING CENTER OF THREE RIVERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK-KUREK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-296-1550
Mailing Address - Street 1:7445 LIBERTY WOODS LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3911
Mailing Address - Country:US
Mailing Address - Phone:937-296-1550
Mailing Address - Fax:937-296-1540
Practice Address - Street 1:7800 JANDARACRES DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-2032
Practice Address - Country:US
Practice Address - Phone:513-941-0787
Practice Address - Fax:513-941-3970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6277314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2744383Medicaid
OH365081Medicare Oscar/Certification