Provider Demographics
NPI:1063754711
Name:BLC DAYTON GC LLC
Entity type:Organization
Organization Name:BLC DAYTON GC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LESKOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-918-5000
Mailing Address - Street 1:280 WALDEN WAY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-4461
Mailing Address - Country:US
Mailing Address - Phone:937-427-0060
Mailing Address - Fax:
Practice Address - Street 1:280 WALDEN WAY
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45440-4461
Practice Address - Country:US
Practice Address - Phone:937-427-0060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKDALE SENIOR LIVING INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-20
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2078R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0098533Medicaid