Healthcare Provider Details

I. General information

NPI: 1487686218
Provider Name (Legal Business Name): WEST LIBERTY CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6557 US HIGHWAY 68 S
WEST LIBERTY OH
43357-9536
US

IV. Provider business mailing address

6557 US HIGHWAY 68 S
WEST LIBERTY OH
43357-9536
US

V. Phone/Fax

Practice location:
  • Phone: 937-465-5065
  • Fax: 937-465-4390
Mailing address:
  • Phone: 937-465-5065
  • Fax: 937-465-4390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number1637R
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number1637N
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1637N
License Number StateOH

VIII. Authorized Official

Name: MR. MICHAEL S RAY
Title or Position: CEO
Credential:
Phone: 937-465-5065