Organization
NORTHWEST COUNTRY PLACE, INC
Active
Other names
Liberty Country Place
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRY L. LENO (ADMINISTRATOR)
(360) 736-9384
Entity
Organization
Contact information
Practice address
917 S SCHEUBER RD, CENTRALIA, WA 98531-9027
(360) 736-9384
(360) 736-6284
Mailing address
917 S SCHEUBER RD, CENTRALIA, WA 98531-9027
(360) 736-9384
(360) 736-6284
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
NH1138
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4111381
—
WA
Enumeration date
10/05/2005
Last updated
06/13/2011
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