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General NPI Number Information
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NPI Number | 1629062310
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Entity Type | Organization
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Legal Business Name | THE SUITES AT WALNUT CREEK
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Dates
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Enumeration Date | 09/08/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2501 KEYSTONE CLUB DR
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City | DAYTON
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State | OH
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Zip | 45439-4223
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Country | US
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Telephone | 937-299-0194
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Fax | 937-299-1907
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Provider Business Mailing Address
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Address Line | 2501 KEYSTONE CLUB DR
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City | DAYTON
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State | OH
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Zip | 45439-4223
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Country | US
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Telephone | 937-299-0194
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Fax | 937-299-1907
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | MR. JOHN HOCHWALT
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Credential |
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Telephone | 937-293-7703
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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 | 6082
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License Number State | OH
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