Liberty Nursing Center of Fremont, Inc

Primary specialty

Pediatric Skilled Nursing FacilityTaxonomy code 3140N1450X

License

6160 Issued in OH

Legal business name

LIBERTY NURSING CENTER OF FREMONT, INC

Doing business as

Countryside Continuing Care Center

Practice address

1865 Countryside Dr
Fremont, OH 43420-8748

Phone

(419) 334-2602

Fax

(419) 334-6287

NPI assigned

Jul 1, 2006

Organization subpart

No

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

Authorized official

Name

Linda Black-Kurek

Title

President

Phone

(937) 296-1550

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Countryside Continuing Care Center Doing business as

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

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371081600000",
    "number": "1356370472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7445 LIBERTY WOODS LN",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454593911",
            "telephone_number": "419-334-2602",
            "fax_number": "419-334-6287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1865 COUNTRYSIDE DR",
            "city": "FREMONT",
            "state": "OH",
            "postal_code": "434208748",
            "telephone_number": "419-334-2602",
            "fax_number": "419-334-6287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY NURSING CENTER OF FREMONT, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-01",
        "last_updated": "2013-06-13",
        "status": "A",
        "authorized_official_last_name": "BLACK-KUREK",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "937-296-1550"
    },
    "taxonomies": [
        {
            "code": "3140N1450X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility, Nursing Care, Pediatric",
            "state": "OH",
            "license": "6160",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2303055",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Countryside Continuing Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kennedy Elaine Leutenegger, LPC
• Courtney Rubin Levine, DDS
• Suzanne J Lewis, LISW
• Lewton and Assoc Health Care Service
• Liberty Dental Louis M. Carratola DDS LLC
• Liberty Portable X-Ray Ohio LLC
• Liberty Portable X-Ray Ohio LLC
• Life Enhancement Services of Ohio, LLC
• Brittany Light
• Kaitlyn Light

• Pediatric Skilled Nursing Facility in Fremont, OH
• Providers in Fremont, OH by specialty
• Pediatric Skilled Nursing Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2013; 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.