Provider Demographics
NPI:1992112403
Name:GARDEN MANOR TERRACE, INC.
Entity type:Organization
Organization Name:GARDEN MANOR TERRACE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:CR
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:513-424-5321
Mailing Address - Street 1:6898 HAMILTON MIDDLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-7859
Mailing Address - Country:US
Mailing Address - Phone:513-424-5321
Mailing Address - Fax:513-420-5367
Practice Address - Street 1:6898 HAMILTON MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-7859
Practice Address - Country:US
Practice Address - Phone:513-424-5321
Practice Address - Fax:513-420-5367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0987R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility