Healthcare Provider Details

I. General information

NPI: 1154419869
Provider Name (Legal Business Name): LOCUST RIDGE NURSING HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12745 ELM CORNER RD
WILLIAMSBURG OH
45176-9621
US

IV. Provider business mailing address

12745 ELM CORNER RD
WILLIAMSBURG OH
45176-9621
US

V. Phone/Fax

Practice location:
  • Phone: 937-444-2920
  • Fax: 937-444-1009
Mailing address:
  • Phone: 937-444-2920
  • Fax: 937-444-1009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number0771N
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0771N
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number0771N
License Number StateOH

VIII. Authorized Official

Name: PATRICIA A MEEKER
Title or Position: BOARD OF DIRECTOR
Credential:
Phone: 513-797-5144