MEDICARE: WESTERVILLE OPERATOR, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1023794518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERVILLE OPERATOR, LLC

Provider Business Mailing Address
First Line	:	4600 S SYRACUSE ST FL 11
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80237-2750
Country	:	US
Telephone Number	:	303-360-8812
Fax Number	:

Provider Business Practice Location Address
First Line	:	363 BRAUN PL
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-7796
Country	:	US
Telephone Number	:	614-423-4182
Fax Number	:	614-942-6089

Authorized Official
Title or Position	:	MANAGER
Name	:	JEFFREY D. KRAUS
Credential	:
Telephone Number	:	303-360-8812

Provider Enumeration Date	:	06/27/2023
Last Update Date	:	06/27/2023

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