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General NPI Number Information
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NPI Number | 1518957000
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Entity Type | Organization
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Legal Business Name | ELMS RETIREMENT VILLAGE, INC.
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 06/09/2015
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Provider Practice Location Address
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Address Line | 136 S MAIN ST
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City | WELLINGTON
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State | OH
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Zip | 44090-1344
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Country | US
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Telephone | 440-647-2414
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Fax | 440-647-9004
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Provider Business Mailing Address
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Address Line | 136 S MAIN ST
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City | WELLINGTON
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State | OH
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Zip | 44090-1344
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Country | US
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Telephone | 440-647-2414
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Fax | 440-647-9004
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Authorized Official
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Title or Position | EX MEDICARE SPECIALIST
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Name | SARAH E WIEDENMANNOTT
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Credential |
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Telephone | 440-989-5238
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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 | 1194N
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License Number State | OH
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