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NPI Code Detail

MEDICARE: OTTERBEIN GAHANNA, LLC

MEDICARE: OTTERBEIN GAHANNA, 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
1314000000XSkilled Nursing Facility2699NOH

Other Identifiers

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

General Provider Information

NPI Number : 1437548575
Entity Type Code : Organization
Provider Name (Legal Business Name) : OTTERBEIN GAHANNA, LLC
Provider Business Mailing Address
First Line : 580 N STATE ROUTE 741
Second Line :
City : LEBANON
State : OH
Zip : 45036-8839
Country : US
Telephone Number : 513-933-5401
Fax Number : 513-932-1054
Provider Business Practice Location Address
First Line : 402 LIBERTY WAY
Second Line :
City : GAHANNA
State : OH
Zip : 43230-3502
Country : US
Telephone Number : 513-933-5401
Fax Number :
Authorized Official
Title or Position : TREASURER & CFO
Name : JAMES CHRIS GREEN
Credential : CPA
Telephone Number : 513-933-5418
Provider Enumeration Date : 01/13/2015
Last Update Date : 01/06/2016

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Directions to “OTTERBEIN GAHANNA, LLC ” Practice Location

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