Provider Demographics
NPI:1982931770
Name:WEST LIBERTY CARE CENTER, INC.
Entity Type:Organization
Organization Name:WEST LIBERTY CARE CENTER, INC.
Other - Org Name:GREEN HILLS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-465-5065
Mailing Address - Street 1:6557 US HIGHWAY 68 S
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:OH
Mailing Address - Zip Code:43357-9536
Mailing Address - Country:US
Mailing Address - Phone:937-465-5065
Mailing Address - Fax:
Practice Address - Street 1:6557 US HIGHWAY 68 S
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:OH
Practice Address - Zip Code:43357-9536
Practice Address - Country:US
Practice Address - Phone:937-465-5065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory