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General NPI Number Information
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NPI Number | 1518106038
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Entity Type | Organization
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Legal Business Name | PUTNAM HERITAGE ASSISTED LIVING LLC
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Dates
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Enumeration Date | 02/05/2009
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Last Update Date | 02/05/2009
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Provider Practice Location Address
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Address Line | 1380 N LOCUST ST
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City | OTTAWA
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State | OH
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Zip | 45875-1163
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Country | US
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Telephone | 419-523-5152
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Fax | 419-523-5153
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Provider Business Mailing Address
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Address Line | 1380 N LOCUST ST
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City | OTTAWA
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State | OH
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Zip | 45875-1163
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Country | US
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Telephone | 419-523-5152
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Fax | 419-523-5153
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHARLES DAVID
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Credential |
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Telephone | 419-350-5652
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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 | 2417R
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License Number State | OH
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