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General NPI Number Information
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NPI Number | 1376792440
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Entity Type | Organization
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Legal Business Name | THE CENTRUM AT WILLOW BROOK , INC
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Dates
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Enumeration Date | 09/15/2008
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Last Update Date | 09/15/2008
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Provider Practice Location Address
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Address Line | 100 WILLOW BROOK WAY SO.
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City | DELAWARE
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State | OH
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Zip | 43015-3249
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Country | US
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Telephone | 740-369-0048
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Fax | 740-369-7034
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Provider Business Mailing Address
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Address Line | 100 WILLOW BROOK WAY SO.
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City | DELAWARE
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State | OH
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Zip | 43015-3249
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Country | US
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Telephone | 740-369-0048
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Fax | 740-369-7034
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Authorized Official
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Title or Position | CENTRUM MANAGER
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Name | MRS. SUSAN KAY ELEAK
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Credential | R.N.
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Telephone | 740-368-4696
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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 | 5176
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License Number State | OH
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