Healthcare Provider Details

I. General information

NPI: 1730173113
Provider Name (Legal Business Name): SANCTUARY AT WHISPERING MEADOWS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 WILMINGTON AVE
DAYTON OH
45420-1989
US

IV. Provider business mailing address

PO BOX 8309 1207 N HIGH ST
COLUMBUS OH
43201-0309
US

V. Phone/Fax

Practice location:
  • Phone: 937-256-4663
  • Fax: 937-558-1810
Mailing address:
  • Phone: 614-299-3100
  • Fax: 614-299-3813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5247
License Number StateOH

VIII. Authorized Official

Name: DR. ROBERT C BANASIK
Title or Position: PRESIDENT
Credential: PHD
Phone: 614-299-3100