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General NPI Number Information
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NPI Number | 1588772776
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Entity Type | Organization
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Legal Business Name | KETTERING AFFILIATED HEALTH SERVICES
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 08/06/2024
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Provider Practice Location Address
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Address Line | 2175 LEITER ROAD SYCAMORE GLEN HEALTH CENTER
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City | MIAMISBURG
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State | OH
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Zip | 45342
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Country | US
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Telephone | 937-384-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 2110 LEITER RD
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City | MIAMISBURG
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State | OH
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Zip | 45342-3660
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Country | US
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Telephone | 937-914-7054
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Fax | 937-522-7685
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Authorized Official
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Title or Position | KETTERING HEALTH CFO
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Name | TIMOTHY KO
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Credential |
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Telephone | 937-558-3223
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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 | 6000
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License Number State | OH
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