Healthcare Provider Details

I. General information

NPI: 1578691341
Provider Name (Legal Business Name): LIBERTY RETIREMENT COMMUNITY OF MIDDLETOWN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 VANNEST AVE
MIDDLETOWN OH
45042-2770
US

IV. Provider business mailing address

7445 LIBERTY WOODS LN
DAYTON OH
45459-3911
US

V. Phone/Fax

Practice location:
  • Phone: 513-422-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1820N
License Number StateOH

VIII. Authorized Official

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