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NPI Code Detail

MEDICARE: OTTERBEIN PORTAGE VALLEY, INC.

MEDICARE: OTTERBEIN PORTAGE VALLEY, 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
1314000000XSkilled Nursing Facility4762OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20537130002OTHERDMERC

General Provider Information

NPI Number : 1629060058
Entity Type Code : Organization
Provider Name (Legal Business Name) : OTTERBEIN PORTAGE VALLEY, INC.
Provider Business Mailing Address
First Line : 20311 PEMBERVILLE RD
Second Line :
City : PEMBERVILLE
State : OH
Zip : 43450-9413
Country : US
Telephone Number : 419-833-7000
Fax Number : 419-833-5763
Provider Business Practice Location Address
First Line : 20311 PEMBERVILLE RD
Second Line :
City : PEMBERVILLE
State : OH
Zip : 43450-9413
Country : US
Telephone Number : 419-833-7000
Fax Number : 419-833-5763
Authorized Official
Title or Position : AVP FINANCE/CONTROLLER
Name : MRS. RITA C HAWKINS
Credential :
Telephone Number : 513-933-5401
Provider Enumeration Date : 08/22/2005
Last Update Date : 04/24/2017

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Directions to “OTTERBEIN PORTAGE VALLEY, INC. ” Practice Location

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