MEDICARE: WALNUT CREEK AL OPCO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1154178028
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALNUT CREEK AL OPCO LLC

Provider Business Mailing Address
First Line	:	5910 LANDERBROOK DR STE 150
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-6506
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 KEYSTONE CLUB DR
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45439-4223
Country	:	US
Telephone Number	:	330-620-7828
Fax Number	:

Authorized Official
Title or Position	:	VP OF OPERATIONS
Name	:	JEFFREY DEGYANSKY
Credential	:
Telephone Number	:	330-620-7828

Provider Enumeration Date	:	04/30/2024
Last Update Date	:	12/04/2025

Similar Medicare Providers

1629062310 — THE SUITES AT WALNUT CREEK
Practice Location Address:

2501 KEYSTONE CLUB DR
DAYTON, OH
45439-4223

Practice Phone: 937-299-0194
Practice Fax: 937-299-1907

1568220168 — SARAH HIBBARD
Practice Location Address:

3411 OFFICE PARK DR STE 200
KETTERING, OH
45439-2295

Practice Phone: 937-802-5440
Practice Fax:

1457207631 — MICHAEL PHIPPS
Practice Location Address:

3411 OFFICE PARK DR STE 200
KETTERING, OH
45439-2295

Practice Phone: 937-802-5440
Practice Fax:

1396578373 — DANIEL TODD BOURNE
Practice Location Address:

3033 KETTERING BLVD STE 324
MORAINE, OH
45439-1948

Practice Phone: 937-882-3800
Practice Fax:

1720059256 — DR. SHEILA N RAJARATNAM MD
Practice Location Address:

3180 KETTERING BLVD
DAYTON, OH
45439-1924

Practice Phone: 937-297-6072
Practice Fax: 937-293-0969

1851396659 — DR. MARK T RORRER D.O.
Practice Location Address:

3033 KETTERING BLVD , SUITE 100
MORAINE, OH
45439-1962

Practice Phone: 937-293-2133
Practice Fax: 937-293-2161

Directions to “WALNUT CREEK AL OPCO LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.