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Organization

ELMS RETIREMENT VILLAGE, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SARAH E WIEDENMANNOTT (EX MEDICARE SPECIALIST)
(440) 989-5238
Entity
Organization

Contact information

Practice address
136 S MAIN ST, WELLINGTON, OH 44090-1344
(440) 647-2414
(440) 647-9004
Mailing address
136 S MAIN ST, WELLINGTON, OH 44090-1344
(440) 647-2414
(440) 647-9004

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1194N
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000156405
ANTHEM
OH
01
000000357031
ANTHEM PT
OH
01
000000357040
ANTHEM OT
OH
01
000000357041
ANTHEM ST
OH
05
0459276
OH
Enumeration date
10/26/2005
Last updated
06/09/2015
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