Healthcare Provider Details

I. General information

NPI: 1215327010
Provider Name (Legal Business Name): WALNUT GROVE NH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2015
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 WALNUT ST
COSHOCTON OH
43812-2263
US

IV. Provider business mailing address

1433 WALNUT ST
COSHOCTON OH
43812-2263
US

V. Phone/Fax

Practice location:
  • Phone: 740-623-4233
  • Fax:
Mailing address:
  • Phone: 740-623-4233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2586N
License Number StateOH

VIII. Authorized Official

Name: RONALD J SWARTZ
Title or Position: VICE PRESIDENT AND CFO
Credential:
Phone: 813-635-9500