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General NPI Number Information
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NPI Number | 1285669119
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Entity Type | Organization
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Legal Business Name | LIBERTY TERRACE HEALTHCARE AND REHABILITATION CENTER, LLC
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 01/26/2016
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Provider Practice Location Address
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Address Line | 2201 GLENN HENDREN DR
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City | LIBERTY
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State | MO
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Zip | 64068
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Country | US
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Telephone | 816-792-2211
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Fax | 816-792-0708
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Provider Business Mailing Address
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Address Line | 2201 GLENN HENDREN DR
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City | LIBERTY
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State | MO
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Zip | 64068
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Country | US
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Telephone | 816-792-2211
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Fax | 816-792-0708
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Authorized Official
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Title or Position | ASSISTANT SECRETARY
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Name | MICHAEL T. BERG
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Credential |
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Telephone | 505-468-4752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 041547
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License Number State | MO
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