Healthcare Provider Details

I. General information

NPI: 1629052139
Provider Name (Legal Business Name): ELIZABETH SCOTT COMMUNITY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 ALBON RD
MAUMEE OH
43537-9752
US

IV. Provider business mailing address

2720 ALBON RD
MAUMEE OH
43537-9752
US

V. Phone/Fax

Practice location:
  • Phone: 419-865-3002
  • Fax: 419-865-1283
Mailing address:
  • Phone: 419-865-3002
  • Fax: 419-865-1283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0184
License Number StateOH

VIII. Authorized Official

Name: MR. ROBERT C. DENNIE
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 419-724-5156