Organization Active NPI

Liberty Retirement Community of Lima Inc

  • Skilled Nursing Facility
  • Lima, OH
National Provider Identifier
1366989550
Registry record updated Jan 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
LIBERTY RETIREMENT COMMUNITY OF LIMA INC
Practice address
2440 Baton Rouge
Lima, OH 45805-5104
Phone
(419) 331-2273
NPI assigned
Jan 25, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2017

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

Authorized official

Name
Linda M Black-Kurek
Title
President
Phone
(937) 296-1550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

2440 Baton Rouge
Lima, OH 45805-5104

Mailing address

4336 W Franklin St
Bellbrook, OH 45305-1551
Phone (937) 296-1550

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170612000660 OH Part A Provider - Skilled Nursing Facility 1153699327 Practice locations: Lima, OH

Skilled nursing facility certification: CCN 365936

Legal name
LIBERTY RETIREMENT COMMUNITY OF LIMA INC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 1, 1993
Last certification
May 8, 2024
Beds
60
Ownership / control type
Corporation
Organization structure
CorporationProprietary
Incorporated
Jan 5, 2017 in OH
Enrollment address
2440 Baton Rouge Ave
Lima, OH 45805-5104
Nursing home name
LIBERTY RETIREMENT COMMUNITY OF LIMA INC

Care Compare: Nursing home

Medicare Care Compare
Listed as
Liberty Retirement Community of Lima IncCCN 365936 · All quality measures
Overall star rating
2 of 5
Health inspections
1 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Dec 1, 1993
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6046.2 residents per day on average
Penalties (3 years)
1Fines totaling $25,495

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D0351345Liberty Retirement Community of Lima2440 Baton Rouge Avenue, Lima, OH 45805Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Locations

4336 W Franklin St
Bellbrook, OH 45305
Phone (937) 296-1550

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Linda Black-Kurek Individual 5% Or Greater Direct Ownership Interest Apr 21, 2017 90%
Corporate OfficerPresident, Ceo, Board Chair, Man Apr 21, 2017
Corporate DirectorPresident, Ceo, Board Chair, Man Apr 21, 2017
Operational/Managerial ControlPresident, Ceo, Manager Apr 21, 2017
Bruce T Carpenter Individual 5% Or Greater Direct Ownership Interest Apr 21, 2017 10%
Corporate OfficerV-President, Asst Secretary & Bo Apr 21, 2017
Corporate DirectorV-President, Asst Secretary & Bo Apr 21, 2017

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1485302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485302400000",
    "number": "1366989550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4336 W FRANKLIN ST",
            "city": "BELLBROOK",
            "state": "OH",
            "postal_code": "453051551",
            "telephone_number": "937-296-1550",
            "fax_number": "937-296-1540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2440 BATON ROUGE",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458055104",
            "telephone_number": "419-331-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIBERTY RETIREMENT COMMUNITY OF LIMA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-25",
        "last_updated": "2017-01-25",
        "status": "A",
        "authorized_official_last_name": "BLACK-KUREK",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "937-296-1550"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lima, OH

Sources for this page

Verify at the official NPI Registry.