Healthcare Provider Details

I. General information

NPI: 1841801347
Provider Name (Legal Business Name): ELMWOOD OF FREMONT, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 FANGBONER RD
FREMONT OH
43420-1128
US

IV. Provider business mailing address

441 N BROADWAY ST
GREEN SPRINGS OH
44836-9689
US

V. Phone/Fax

Practice location:
  • Phone: 419-332-6533
  • Fax: 419-332-6535
Mailing address:
  • Phone: 419-332-3378
  • Fax: 419-639-2519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: KATHY KAY HUNT
Title or Position: MANAGING MEMBER
Credential:
Phone: 419-332-3378