Healthcare Provider Details

I. General information

NPI: 1134227150
Provider Name (Legal Business Name): ELMWOOD AT THE SHAWHAN, LCC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 S WASHINGTON ST
TIFFIN OH
44883-2350
US

IV. Provider business mailing address

430 N BROADWAY ST
GREEN SPRINGS OH
44836-9601
US

V. Phone/Fax

Practice location:
  • Phone: 419-447-6885
  • Fax: 419-447-6886
Mailing address:
  • Phone: 419-639-2581
  • Fax: 419-639-2519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number5601
License Number StateOH

VIII. Authorized Official

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