Organization
LOCUST RIDGE HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HAYLEY B WILLIAMS (ATTORNEY)
(216) 706-3936
Entity
Organization
Contact information
Practice address
12745 ELM CORNER RD, WILLIAMSBURG, OH 45176-9621
(937) 444-2920
(937) 444-1009
Mailing address
15 AMERICA AVE UNIT 304, LAKEWOOD, NJ 08701-4582
(513) 487-7479
(732) 276-5556
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0771N
STATE ID
OH
Enumeration date
11/29/2018
Last updated
11/29/2018
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