Provider Demographics
NPI:1932931045
Name:CRANBERRY PARK NEW ALBANY
Entity type:Organization
Organization Name:CRANBERRY PARK NEW ALBANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KACY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLILAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-855-8866
Mailing Address - Street 1:5691 THOMPSON ROAD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230
Mailing Address - Country:US
Mailing Address - Phone:614-855-8866
Mailing Address - Fax:614-345-0527
Practice Address - Street 1:5691 THOMPSON ROAD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230
Practice Address - Country:US
Practice Address - Phone:614-855-8866
Practice Address - Fax:614-345-0527
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW ALBANY CARE CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility