Healthcare Provider Details

I. General information

NPI: 1134453194
Provider Name (Legal Business Name): ELMWOOD OF GREEN SPRINGS, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N BROADWAY ST
GREEN SPRINGS OH
44836-9653
US

IV. Provider business mailing address

430 N BROADWAY ST
GREEN SPRINGS OH
44836-9601
US

V. Phone/Fax

Practice location:
  • Phone: 419-639-2581
  • Fax: 419-639-2519
Mailing address:
  • Phone: 419-639-2581
  • Fax: 419-639-2519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number3594
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0296N
License Number StateOH

VIII. Authorized Official

Name: MS. KATHY KAY HUNT
Title or Position: MEMBER
Credential: LNHA
Phone: 419-639-2581