Provider Demographics
NPI:1417097056
Name:NEW LIBERTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:NEW LIBERTY HOSPITAL DISTRICT
Other - Org Name:LIBERTY HOSPITAL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:FEESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-792-7011
Mailing Address - Street 1:2525 GLENN HENDREN DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-9625
Mailing Address - Country:US
Mailing Address - Phone:816-792-7021
Mailing Address - Fax:816-792-7296
Practice Address - Street 1:2525 GLENN HENDREN DR
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-9625
Practice Address - Country:US
Practice Address - Phone:816-792-7021
Practice Address - Fax:816-792-7296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO33-23251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO580568608Medicaid
MO267091Medicare Oscar/Certification