Provider Demographics
NPI:1992797328
Name:OTTERBEIN LEBANON
Entity type:Organization
Organization Name:OTTERBEIN LEBANON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AVP FINANCE/CONTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:C
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-933-5401
Mailing Address - Street 1:585 N STATE ROUTE 741
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-8840
Mailing Address - Country:US
Mailing Address - Phone:513-932-2020
Mailing Address - Fax:513-932-4722
Practice Address - Street 1:585 N STATE ROUTE 741
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-8840
Practice Address - Country:US
Practice Address - Phone:513-932-2020
Practice Address - Fax:513-932-4722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X
OH4454314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
4488210001OtherDMERC
OH6636331Medicaid
OH6636331Medicaid