Basic Information
| Provider Information | |||||||||
| NPI: | 1891025425 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIBERTY NURSING CENTER OF RIVERVIEW, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7445 LIBERTY WOODS LN | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454593911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372961550 | ||||||||
| FaxNumber: | 9372961540 | ||||||||
| Practice Location | |||||||||
| Address1: | 5999 BENDER RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452331601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133478320 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2010 | ||||||||
| LastUpdateDate: | 02/03/2010 | ||||||||
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| AuthorizedOfficialLastName: | BLACK-KUREK | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9372961550 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | CPA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 1297 | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 3001138 | 05 | OH | MEDICAID |