Basic Information
| Provider Information | |||||||||
| NPI: | 1902893597 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIBERTY SENIOR LIVING-N H L L C | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | WESTWOOD MANOR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3073 HORSESHOE DR S | ||||||||
| Address2: | STE 102 | ||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341046144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399633400 | ||||||||
| FaxNumber: | 2399633401 | ||||||||
| Practice Location | |||||||||
| Address1: | 5015 SW 28TH ST | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666142319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852730886 | ||||||||
| FaxNumber: | 7852730959 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | RAWLES | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 2399633400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | N089019 | KS | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.