Healthcare Provider Details

I. General information

NPI: 1649935669
Provider Name (Legal Business Name): BUCKEYE FOREST AT WATERVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8885 BROWNING DR
WATERVILLE OH
43566-9701
US

IV. Provider business mailing address

1800 ROCKAWAY AVE STE 200
HEWLETT NY
11557-1668
US

V. Phone/Fax

Practice location:
  • Phone: 419-878-8523
  • Fax:
Mailing address:
  • Phone: 516-330-0009
  • Fax:

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: ANN MORHAIME
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 516-330-0009