Organization
GRACEWORKS ENHANCED LIVING
Active
Parent organization
GRACEWORKS ENHANCED LIVING
Other names
Kemper Meadow Home
Organization subpart
Yes
Provider details
NPI number
Legal business name
GRACEWORKS ENHANCED LIVING
Authorized official
MR. MICHAEL W ALLEN (VICE PRESIDENT, FINANCE & FACILITIE)
(937) 436-6885
Entity
Organization
Contact information
Practice address
1045 KEMPER MEADOW DRIVE, FOREST PARK, OH 45240
(513) 648-0830
(513) 612-6545
Mailing address
11370 SPRINGFIELD PIKE, CINCINNATI, OH 45246-4202
(513) 612-6500
(513) 612-6546
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0090195
—
OH
01
—
36-G673
CMS CERTIFICATION NUMBER (CCN)
OH
Enumeration date
08/26/2013
Last updated
12/23/2020
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