Northwest Country Place, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH1138 Issued in WA

Legal business name

NORTHWEST COUNTRY PLACE, INC

Doing business as

Liberty Country Place

Practice address

917 S Scheuber Rd
Centralia, WA 98531-9027

Phone

(360) 736-9384

Fax

(360) 736-6284

NPI assigned

Oct 5, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Terry L. Leno

Title

Administrator

Phone

(360) 736-9384

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Liberty Country Place Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307923200000",
    "number": "1245227131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "917 S SCHEUBER RD",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985319027",
            "telephone_number": "360-736-9384",
            "fax_number": "360-736-6284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "917 S SCHEUBER RD",
            "city": "CENTRALIA",
            "state": "WA",
            "postal_code": "985319027",
            "telephone_number": "360-736-9384",
            "fax_number": "360-736-6284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST COUNTRY PLACE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-05",
        "last_updated": "2011-06-13",
        "status": "A",
        "authorized_official_last_name": "LENO",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "360-736-9384",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WA",
            "license": "NH1138",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4111381",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Liberty Country Place",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Vanessa L Nobles, RN, BSN
• Amber Dawn Norris, NAC
• Katherine M Norris, RN, BSN
• Ronald Ty Norsworthy
• Suzanne Joy Northcutt, RN
• Northwest Healthcare Alliance, Inc. (Assured Home Health & Hospice)
• Northwest Healthcare Alliance, Inc. (Assured Home Health & Hospice)
• Jeremy Glenn Nugent, CM60686561
• Archibald Nyamekye, CRNA
• Kyle O'Connor, DDS

• Skilled Nursing Facility in Centralia, WA
• Providers in Centralia, WA by specialty
• Skilled Nursing Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.