Provider Demographics
NPI:1699582064
Name:OTTERBEIN TIPP CITY LLC
Entity type:Organization
Organization Name:OTTERBEIN TIPP CITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER & CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:513-933-5418
Mailing Address - Street 1:3855 LOWER MARKET ST STE 300
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-7654
Mailing Address - Country:US
Mailing Address - Phone:513-933-5401
Mailing Address - Fax:
Practice Address - Street 1:4375 S COUNTY ROAD 25A
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-2956
Practice Address - Country:US
Practice Address - Phone:937-506-2703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility