Provider Demographics
NPI:1104098870
Name:ELMWOOD VILLAGE
Entity type:Organization
Organization Name:ELMWOOD VILLAGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:K
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-639-2581
Mailing Address - Street 1:430 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:GREEN SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:44836-9601
Mailing Address - Country:US
Mailing Address - Phone:419-639-2581
Mailing Address - Fax:419-639-2519
Practice Address - Street 1:222 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:GREEN SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:44836
Practice Address - Country:US
Practice Address - Phone:419-639-0752
Practice Address - Fax:419-639-0751
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELMWOOD CENTERS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-02
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7210273315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1104098870OtherNPI
OH2806100OtherNPI
OH1104098870OtherNPI