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General NPI Number Information
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NPI Number | 1619112711
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Entity Type | Organization
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Legal Business Name | OTTERBEIN NORTH SHORE RETIREMENT COMMUNITY
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Dates
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Enumeration Date | 12/04/2008
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Last Update Date | 12/04/2008
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Provider Practice Location Address
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Address Line | 9400 N SHORE BLVD
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City | LAKESIDE MARBLEHEAD
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State | OH
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Zip | 43440-1337
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Country | US
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Telephone | 419-798-8203
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Fax | 419-798-4662
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Provider Business Mailing Address
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Address Line | 9400 N SHORE BLVD
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City | LAKESIDE MARBLEHEAD
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State | OH
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Zip | 43440-1337
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Country | US
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Telephone | 419-798-8203
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Fax | 419-798-4662
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | RHONDA A NAGEL
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Credential | LNHA
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Telephone | 419-798-8203
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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 | 2057R
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License Number State | OH
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