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General NPI Number Information
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NPI Number | 1245235845
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Entity Type | Organization
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Legal Business Name | EVANGELICAL RETIREMENT VILLAGES,INC. OF DAYTON DBA FRIENDSHIP VILLAGE
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Dates
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Enumeration Date | 06/20/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5790 DENLINGER RD
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City | DAYTON
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State | OH
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Zip | 45426-1838
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Country | US
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Telephone | 937-838-5581
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Fax | 937-854-8203
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Provider Business Mailing Address
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Address Line | 5790 DENLINGER RD
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City | DAYTON
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State | OH
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Zip | 45426-1838
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Country | US
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Telephone | 937-838-5581
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Fax | 937-854-8203
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PETER D CRANE
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Credential |
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Telephone | 937-837-5581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 2380
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License Number State | OH
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