Healthcare Provider Details

I. General information

NPI: 1265473003
Provider Name (Legal Business Name): LIBERTY/MATRIX OF WESTWOOD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7445 LIBERTY WOODS LN
DAYTON OH
45459-3911
US

IV. Provider business mailing address

2171 HARRISON AVE
CINCINNATI OH
45211-8159
US

V. Phone/Fax

Practice location:
  • Phone: 937-296-1550
  • Fax: 937-296-1540
Mailing address:
  • Phone: 513-662-5800
  • Fax: 513-389-4505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number520042
License Number StateOH

VIII. Authorized Official

Name: LINDA M BLACK-KUREK
Title or Position: PRESIDENT
Credential:
Phone: 937-296-1550