Organization
EMBASSY GARDEN COURT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL B BERGSTEN (CEO)
(937) 825-6622
Entity
Organization
Contact information
Practice address
4911 COVENANT HOUSE DR, DAYTON, OH 45426-2007
(937) 837-2651
(937) 837-5831
Mailing address
544 ENTERPRISE DRIVE, LEWIS CENTER, OH 43035
(937) 825-6622
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1515N
OH
Other
Enumeration date
01/16/2015
Last updated
01/25/2017
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