Healthcare Provider Details

I. General information

NPI: 1356370472
Provider Name (Legal Business Name): LIBERTY NURSING CENTER OF FREMONT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1865 COUNTRYSIDE DR
FREMONT OH
43420-8748
US

IV. Provider business mailing address

7445 LIBERTY WOODS LN
DAYTON OH
45459-3911
US

V. Phone/Fax

Practice location:
  • Phone: 419-334-2602
  • Fax: 419-334-6287
Mailing address:
  • Phone: 419-334-2602
  • Fax: 419-334-6287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number6160
License Number StateOH

VIII. Authorized Official

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