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General NPI Number Information
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NPI Number | 1134227150
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Entity Type | Organization
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Legal Business Name | ELMWOOD AT THE SHAWHAN, LCC
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 54 S WASHINGTON ST
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City | TIFFIN
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State | OH
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Zip | 44883-2350
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Country | US
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Telephone | 419-447-6885
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Fax | 419-447-6886
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Provider Business Mailing Address
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Address Line | 430 N BROADWAY ST
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City | GREEN SPRINGS
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State | OH
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Zip | 44836-9601
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Country | US
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Telephone | 419-639-2581
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Fax | 419-639-2519
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Authorized Official
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Title or Position | CEO
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Name | MS. KATHY K HUNT
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Credential | ADMINISTRATOR
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Telephone | 419-639-2581
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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 | 5601
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License Number State | OH
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