Healthcare Provider Details

I. General information

NPI: 1245375591
Provider Name (Legal Business Name): WILLOW KNOLL RETIREMENT COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 VANNEST AVE
MIDDLETOWN OH
45042-2770
US

IV. Provider business mailing address

4400 VANNEST AVE
MIDDLETOWN OH
45042-2770
US

V. Phone/Fax

Practice location:
  • Phone: 513-422-5600
  • Fax: 513-422-6532
Mailing address:
  • Phone: 513-422-5600
  • Fax: 513-422-6532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID LENKENSDOFER
Title or Position: CFO
Credential:
Phone: 765-759-0230