Healthcare Provider Details

I. General information

NPI: 1649191123
Provider Name (Legal Business Name): LANDMARK RESIDENTIAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 KERMIT AVE
WILLIAMSBURG OH
45176-1511
US

IV. Provider business mailing address

5699 TRICOUNTY HWY
SARDINIA OH
45171-9710
US

V. Phone/Fax

Practice location:
  • Phone: 513-940-2837
  • Fax:
Mailing address:
  • Phone: 513-940-2837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: WHITNEY ELIZABETH GREENE
Title or Position: DOO
Credential:
Phone: 513-940-2837