MEDICARE: LOCUST RIDGE NURSING HOME INC

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	313M00000X	Nursing Facility/Intermediate Care Facility	0771N	OH
2	314000000X	Skilled Nursing Facility	0771N	OH
3	311500000X	Alzheimer Center (Dementia Center)	0771N	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154419869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOCUST RIDGE NURSING HOME INC

Provider Business Mailing Address
First Line	:	12745 ELM CORNER RD
Second Line	:
City	:	WILLIAMSBURG
State	:	OH
Zip	:	45176-9621
Country	:	US
Telephone Number	:	937-444-2920
Fax Number	:	937-444-1009

Provider Business Practice Location Address
First Line	:	12745 ELM CORNER RD
Second Line	:
City	:	WILLIAMSBURG
State	:	OH
Zip	:	45176-9621
Country	:	US
Telephone Number	:	937-444-2920
Fax Number	:	937-444-1009

Authorized Official
Title or Position	:	BOARD OF DIRECTOR
Name	:	PATRICIA A MEEKER
Credential	:
Telephone Number	:	513-797-5144

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	09/11/2025

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Directions to “LOCUST RIDGE NURSING HOME INC ” Practice Location

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