Healthcare Provider Details

I. General information

NPI: 1972642510
Provider Name (Legal Business Name): NEW LIBERTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 06/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 GLENN HENDREN DR
LIBERTY MO
64068-9625
US

IV. Provider business mailing address

2525 GLENN HENDREN DR
LIBERTY MO
64068-9625
US

V. Phone/Fax

Practice location:
  • Phone: 816-792-7021
  • Fax: 816-792-7296
Mailing address:
  • Phone: 816-792-7021
  • Fax: 816-792-7296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number269-31
License Number StateMO

VIII. Authorized Official

Name: DAVID W. FEESS
Title or Position: ADMINISTRATOR
Credential:
Phone: 816-792-7011