Healthcare Provider Details

I. General information

NPI: 1083620603
Provider Name (Legal Business Name): LIBERTY NURSING CENTERS OF MANSFIELD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 LEXINGTON AVE
MANSFIELD OH
44907-1502
US

IV. Provider business mailing address

535 LEXINGTON AVE
MANSFIELD OH
44907-1502
US

V. Phone/Fax

Practice location:
  • Phone: 419-756-7111
  • Fax: 419-756-0835
Mailing address:
  • Phone: 419-756-7111
  • Fax: 419-756-0835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1447N
License Number StateOH

VIII. Authorized Official

Name: MICHELLE SMOLLEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 419-756-7111