LIBERTY DEVELOPMENT COMPANY LLC NPI 1023121340

NPI Information

NPI: 1023121340
Provider Name: LIBERTY DEVELOPMENT COMPANY, LLC

Doing Business As: THE COURTYARD AT COLFAX

Classification: Assisted Living Facility - 310400000X
Entity Type: Organization

Address:
300 S MAIN ST
COLFAX, WA
ZIP 99111
Phone: (509) 397-6123
Get Directions

LIBERTY DEVELOPMENT COMPANY, LLC is an assisted living facility in Colfax, WA. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. LIBERTY DEVELOPMENT COMPANY, LLC NPI is 1023121340. The provider is registered as an organization entity type.
The provider Is Doing Business As The Courtyard At Colfax.

The provider's business location address is:

300 S MAIN ST
COLFAX, WA
ZIP 99111-971
Phone: (509) 397-6123
Fax: (509) 397-6367

The provider's authorized official is Shauna J. Miller .
The authorized official title is President and has the following contact phone number (208) 772-2743.

The CLIA number assigned to this NPI record is 50D2250625 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/17/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	310400000X	Assisted Living Facility		BH 1624	WASHINGTON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	BH 1624	OTHER	WASHINGTON	WA BOARDING HOME PROVIDER
2	865214	MEDICAID	WASHINGTON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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