Healthcare Provider Details

I. General information

NPI: 1568522092
Provider Name (Legal Business Name): ECHOING HILLS VILLAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 02/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5455 SALEM BEND DR
DAYTON OH
45426-1609
US

IV. Provider business mailing address

36272 COUNTY ROAD 79
WARSAW OH
43844-9770
US

V. Phone/Fax

Practice location:
  • Phone: 937-854-5151
  • Fax: 937-854-5153
Mailing address:
  • Phone: 740-327-2311
  • Fax: 740-327-6371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number5710225
License Number StateOH

VIII. Authorized Official

Name: MR. JOHN R SWANSON
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 740-327-2311