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General NPI Number Information
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NPI Number | 1013626373
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Entity Type | Organization
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Legal Business Name | HERITAGE SENIOR LIVING OF MARYSVILLE
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Dates
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Enumeration Date | 11/15/2022
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Last Update Date | 11/15/2022
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Provider Practice Location Address
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Address Line | 1565 LONDON AVE
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City | MARYSVILLE
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State | OH
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Zip | 43040-6809
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Country | US
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Telephone | 937-738-7342
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Fax | 937-518-7601
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Provider Business Mailing Address
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Address Line | 1565 LONDON AVE
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City | MARYSVILLE
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State | OH
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Zip | 43040-6809
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Country | US
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Telephone | 937-738-7342
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Fax | 937-518-7601
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Authorized Official
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Title or Position | CEO
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Name | ANGELA SHARP
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Credential | RN
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Telephone | 937-738-7342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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