Organization
OTTERBEIN GAHANNA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES CHRIS GREEN CPA (TREASURER & CFO)
(513) 933-5418
Entity
Organization
Contact information
Practice address
402 LIBERTY WAY, GAHANNA, OH 43230-3502
(513) 933-5401
Mailing address
580 N STATE ROUTE 741, LEBANON, OH 45036-8839
(513) 933-5401
(513) 932-1054
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2699N
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0118752
—
OH
Enumeration date
01/13/2015
Last updated
01/06/2016
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