Provider Demographics
NPI:1538567995
Name:WC-MARYSVILLE OPS, LLC
Entity type:Organization
Organization Name:WC-MARYSVILLE OPS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUMAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-642-2202
Mailing Address - Street 1:717 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-1639
Mailing Address - Country:US
Mailing Address - Phone:937-642-2202
Mailing Address - Fax:937-642-2202
Practice Address - Street 1:717 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-1639
Practice Address - Country:US
Practice Address - Phone:937-642-2202
Practice Address - Fax:937-642-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2054R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility