# NORTHWEST COUNTRY PLACE, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Liberty Country Place
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245227131
- **Authorized official:** MR. TERRY L. LENO (ADMINISTRATOR)
- **Authorized official phone:** (360) 736-9384

## Contact information

- **Practice address:** 917 S SCHEUBER RD, CENTRALIA, WA 98531-9027
- **Practice address phone:** (360) 736-9384
- **Practice address fax:** (360) 736-6284
- **Mailing address:** 917 S SCHEUBER RD, CENTRALIA, WA 98531-9027
- **Mailing address phone:** (360) 736-9384
- **Mailing address fax:** (360) 736-6284

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | NH1138 | WA | Yes |

## Other

- **Enumeration date:** 10/05/2005
- **Last updated:** 06/13/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4111381 | — | WA |