Provider Demographics
NPI:1902893597
Name:LIBERTY SENIOR LIVING-N H L L C
Entity Type:Organization
Organization Name:LIBERTY SENIOR LIVING-N H L L C
Other - Org Name:WESTWOOD MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:RAWLES
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:239-963-3400
Mailing Address - Street 1:3073 HORSESHOE DR S
Mailing Address - Street 2:STE 102
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34104-6144
Mailing Address - Country:US
Mailing Address - Phone:239-963-3400
Mailing Address - Fax:239-963-3401
Practice Address - Street 1:5015 SW 28TH ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-2319
Practice Address - Country:US
Practice Address - Phone:785-273-0886
Practice Address - Fax:785-273-0959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN089019314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS17-5463Medicare ID - Type Unspecified