Healthcare Provider Details

I. General information

NPI: 1366989550
Provider Name (Legal Business Name): LIBERTY RETIREMENT COMMUNITY OF LIMA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2017
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 BATON ROUGE
LIMA OH
45805-5104
US

IV. Provider business mailing address

4336 W FRANKLIN ST
BELLBROOK OH
45305-1551
US

V. Phone/Fax

Practice location:
  • Phone: 419-331-2273
  • Fax:
Mailing address:
  • Phone: 937-296-1550
  • Fax: 937-296-1540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

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