Organization
GRACE BRETHREN VILLAGE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MIKE JACKIE MONTGOMERY LNHA (ASSISTANT ADMINISTRATOR)
(937) 836-4011
Entity
Organization
Contact information
Practice address
1010 TAYWOOD RD, ENGLEWOOD, OH 45322-2400
(937) 836-4011
Mailing address
1010 TAYWOOD RD, ENGLEWOOD, OH 45322-2400
(937) 836-4011
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2050
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
97156170
TAW EXEMPT NUMBER
OH
Enumeration date
11/02/2005
Last updated
04/27/2012
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