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General NPI Number Information
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NPI Number | 1134160963
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Entity Type | Organization
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Legal Business Name | LIBERTY/MATRIX OF OXFORD LLC
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7445 LIBERTY WOODS LN
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City | DAYTON
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State | OH
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Zip | 45459-3911
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Country | US
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Telephone | 937-296-1550
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Fax | 937-296-1540
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Provider Business Mailing Address
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Address Line | 6099 FAIRFIELD RD
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City | OXFORD
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State | OH
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Zip | 45056-1507
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Country | US
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Telephone | 513-523-6353
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Fax | 513-523-1183
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Authorized Official
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Title or Position | PRESIDENT
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Name | LINDA M BLACK-KUREK
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Credential |
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Telephone | 937-296-1550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number | OH00725
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License Number State | OH
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