Healthcare Provider Details

I. General information

NPI: 1790871283
Provider Name (Legal Business Name): ELMWOOD CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 ACADEMY ST
GREEN SPRINGS OH
44836-9655
US

IV. Provider business mailing address

430 N BROADWAY ST
GREEN SPRINGS OH
44836-9601
US

V. Phone/Fax

Practice location:
  • Phone: 419-639-2061
  • Fax: 419-639-2519
Mailing address:
  • Phone: 419-639-2581
  • Fax: 419-639-2519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number7210270
License Number StateOH

VIII. Authorized Official

Name: MISS KATHY K HUNT
Title or Position: CEO
Credential: ADMINISTRATOR
Phone: 419-639-2581