MEDICARE: WILLOW BROOK CHRISTIAN SERVICES

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	314000000X	Skilled Nursing Facility	1315N	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346210515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOW BROOK CHRISTIAN SERVICES

Provider Business Mailing Address
First Line	:	100 WILLOW BROOK WAY S
Second Line	:
City	:	DELAWARE
State	:	OH
Zip	:	43015
Country	:	US
Telephone Number	:	740-369-0048
Fax Number	:	740-368-4630

Provider Business Practice Location Address
First Line	:	55 LAZELLE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-1419
Country	:	US
Telephone Number	:	614-885-3300
Fax Number	:	614-885-8476

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	MRS. TERRY G MARTINI
Credential	:
Telephone Number	:	740-368-4621

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	08/22/2020

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Directions to “WILLOW BROOK CHRISTIAN SERVICES ” Practice Location

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