Provider Demographics
NPI:1134117708
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:OAK RIDGE ACRES NURSING FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WOLNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:785-742-2149
Mailing Address - Street 1:201 SIOUX AVE
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:KS
Mailing Address - Zip Code:66434-2756
Mailing Address - Country:US
Mailing Address - Phone:785-742-2149
Mailing Address - Fax:785-742-2881
Practice Address - Street 1:201 SIOUX AVE
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:KS
Practice Address - Zip Code:66434-2756
Practice Address - Country:US
Practice Address - Phone:785-742-2149
Practice Address - Fax:785-742-2881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN007002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS17-5485Medicare ID - Type UnspecifiedMUTUAL OF OMAHA MEDICARE