=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790656460
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE WATERFORD AT LEVIS COMMONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2025
-----------------------------------------------------
Last Update Date | 09/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7100 S WILKINSON WAY
-----------------------------------------------------
City | PERRYSBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43551-2590
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-874-2564
-----------------------------------------------------
Fax | 419-874-2758
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7100 S WILKINSON WAY
-----------------------------------------------------
City | PERRYSBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43551-2590
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-874-2564
-----------------------------------------------------
Fax | 419-874-2758
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SENIOR BUSINESS DIRECTOR
-----------------------------------------------------
Name | KRIS ZIELINSKI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 419-874-2564
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------