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General NPI Number Information
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NPI Number | 1437552288
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Entity Type | Organization
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Legal Business Name | HERITAGE CORNER HEALTH CARE CAMPUS
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Dates
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Enumeration Date | 10/07/2014
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Last Update Date | 10/07/2014
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Provider Practice Location Address
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Address Line | 1069 KLOTZ RD
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City | BOWLING GREEN
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State | OH
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Zip | 43402-4828
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Country | US
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Telephone | 419-728-7015
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Fax |
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Provider Business Mailing Address
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Address Line | 1069 KLOTZ RD
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City | BOWLING GREEN
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State | OH
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Zip | 43402-4828
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | MS. LESLIE ANN DIMICK
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Credential |
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Telephone | 419-728-7015
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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 | 2247R
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License Number State | OH
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