Healthcare Provider Details

I. General information

NPI: 1396736716
Provider Name (Legal Business Name): GARDEN MANOR EXTENDED CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 12/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6898 HAMILTON MIDDLETOWN ROAD
MIDDLETOWN OH
45044-7859
US

IV. Provider business mailing address

6898 HAMILTON MIDDLETOWN RD
MIDDLETOWN OH
45044-7859
US

V. Phone/Fax

Practice location:
  • Phone: 513-424-5321
  • Fax: 513-420-5367
Mailing address:
  • Phone: 513-424-5321
  • Fax: 513-420-5367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2171
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number0987R
License Number StateOH

VIII. Authorized Official

Name: MS. KATHLEEN HAMMON
Title or Position: V.P. MARKETING
Credential:
Phone: 513-699-4651