Healthcare Provider Details

I. General information

NPI: 1285669119
Provider Name (Legal Business Name): LIBERTY TERRACE HEALTHCARE AND REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 GLENN HENDREN DR
LIBERTY MO
64068
US

IV. Provider business mailing address

2201 GLENN HENDREN DR
LIBERTY MO
64068
US

V. Phone/Fax

Practice location:
  • Phone: 816-792-2211
  • Fax: 816-792-0708
Mailing address:
  • Phone: 816-792-2211
  • Fax: 816-792-0708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number041547
License Number StateMO

VIII. Authorized Official

Name: MICHAEL T. BERG
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 505-468-4752