Provider Demographics
NPI:1952725335
Name:GA HC REIT II LIBERTY TRS SUB, LLC
Entity Type:Organization
Organization Name:GA HC REIT II LIBERTY TRS SUB, LLC
Other - Org Name:LIBERTY HEIGHTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:
Authorized Official - Last Name:PROSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-270-9200
Mailing Address - Street 1:12205 GUNSTOCK DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-3624
Mailing Address - Country:US
Mailing Address - Phone:719-488-3170
Mailing Address - Fax:719-481-5059
Practice Address - Street 1:12205 GUNSTOCK DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-3624
Practice Address - Country:US
Practice Address - Phone:719-488-3170
Practice Address - Fax:719-481-5059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO065305Medicare Oscar/Certification