Provider Demographics
NPI:1033940432
Name:WOODLANDS OF LIBERTY LLC
Entity type:Organization
Organization Name:WOODLANDS OF LIBERTY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-446-4980
Mailing Address - Street 1:250 SMOKERISE DR
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8210
Mailing Address - Country:US
Mailing Address - Phone:330-336-3616
Mailing Address - Fax:
Practice Address - Street 1:250 SMOKERISE DR
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8210
Practice Address - Country:US
Practice Address - Phone:330-336-3616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WOODLANDS OF LIBERTY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility