Organization
OTTERBEIN MONCLOVA, LLC
Active
Other names
Avalon by Otterbein Monclova
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES CHRIS GREEN CPA (TREASURER & CFO)
(513) 933-5418
Entity
Organization
Contact information
Practice address
5069 OTTERBEIN WAY, MONCLOVA, OH 43542
(419) 878-0550
(419) 878-3169
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
2503N
OH
314000000X
Skilled Nursing Facility
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2819454
—
OH
Enumeration date
04/09/2007
Last updated
02/09/2015
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