Healthcare Provider Details

I. General information

NPI: 1124906581
Provider Name (Legal Business Name): OTTERBEIN LEBANON RETIREMENT LIVING COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 N STATE ROUTE 741
LEBANON OH
45036-3313
US

IV. Provider business mailing address

3855 LOWER MARKET ST STE 300
LEBANON OH
45036-7654
US

V. Phone/Fax

Practice location:
  • Phone: 513-696-8567
  • Fax:
Mailing address:
  • Phone: 513-933-5401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES GREEN
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 513-933-5418