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1285669119 NPI number — LIBERTY TERRACE HEALTHCARE AND REHABILITATION CENTER, LLC

NPI Number: 1285669119
Health Care Provider/Practitioner: LIBERTY TERRACE HEALTHCARE AND REHABILITATION CENTER, LLC

Information about “1285669119” NPI (LIBERTY TERRACE HEALTHCARE AND REHABILITATION CENTER, LLC) exists in 1285669119 in HTML format HTML  |  1285669119 in plain Text format TXT  |  1285669119 in PDF (Portable Document Format) PDF  |  1285669119 in an XML format XML  formats.

NPI Number : 1285669119 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1285669119",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "SUMMIT CARE LLC",
    "ParentOrgTIN": null,
    "OrgName": "LIBERTY TERRACE HEALTHCARE AND REHABILITATION CENTER, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2201 GLENN HENDREN DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LIBERTY",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "64068",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "816-792-2211",
    "MailingAddressFaxNumber": "816-792-0708",
    "FirstLinePracticeLocationAddress": "2201 GLENN HENDREN DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LIBERTY",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "64068",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "816-792-2211",
    "PracticeLocationAddressFaxNumber": "816-792-0708",
    "EnumerationDate": "07/11/2006",
    "LastUpdateDate": "01/26/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BERG",
    "AuthorizedOfficialFirstName": "MICHAEL",
    "AuthorizedOfficialMiddleName": "T.",
    "AuthorizedOfficialTitle": "ASSISTANT SECRETARY",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "505-468-4752",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "314000000X",
        "TaxonomyName": "Skilled Nursing Facility",
        "LicenseNumber": "041547",
        "LicenseNumberStateCode": "MO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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