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Organization
WELLINGTON ESTATES INC
Active
Organization
WELLINGTON ESTATES INC
Active
Other names
St Charles/St James Place
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ADELBERT H WEBER (ADMINISTRATOR)
(440) 647-2088
Entity
Organization
Contact information
Practice address
101 WEBER CT, WELLINGTON, OH 44090
(440) 647-2088
Mailing address
PO BOX 386, WELLINGTON, OH 44090-0386
(440) 647-2088
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0067898
OHIO MEDICAID PROVIDER NUMBER
OH
01
—
12480
MR/DD LICENSE NO.
OH
01
—
36-G658
CMS CERTIFICATION NUMBER
OH
01
—
4710085
ODMR/DD FACILITY NO.
OH
Enumeration date
05/28/2008
Last updated
10/19/2012
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