Provider Demographics
NPI:1669436218
Name:LIBERTY SQUARE CARE CENTER, LLC
Entity type:Organization
Organization Name:LIBERTY SQUARE CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIMBELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-232-9573
Mailing Address - Street 1:111 SOUTH BOULDER
Mailing Address - Street 2:
Mailing Address - City:NORA SPRINGS
Mailing Address - State:IA
Mailing Address - Zip Code:50458
Mailing Address - Country:US
Mailing Address - Phone:641-792-5680
Mailing Address - Fax:641-792-2630
Practice Address - Street 1:111 SOUTH BOULDER
Practice Address - Street 2:
Practice Address - City:NORA SPRINGS
Practice Address - State:IA
Practice Address - Zip Code:50458
Practice Address - Country:US
Practice Address - Phone:641-792-5680
Practice Address - Fax:641-792-2630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA340777311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0894063Medicaid
IA0232447Medicaid
IA0448449Medicaid