Provider Demographics
NPI:1366504375
Name:LIBERTY NURSING CENTER WILLARD
Entity Type:Organization
Organization Name:LIBERTY NURSING CENTER WILLARD
Other - Org Name:HILLSIDE ACRES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRISP
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:419-935-0148
Mailing Address - Street 1:370 E HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:OH
Mailing Address - Zip Code:44890
Mailing Address - Country:US
Mailing Address - Phone:419-935-0148
Mailing Address - Fax:419-933-6448
Practice Address - Street 1:370 E HOWARD
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890
Practice Address - Country:US
Practice Address - Phone:419-935-0148
Practice Address - Fax:419-933-6448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2245010Medicaid
OH365343Medicare ID - Type Unspecified