Organization
COUNTRY CLUB RETIREMENT CENTER V LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HAYLEY B WILLIAMS (ATTORNEY)
(216) 706-3936
Entity
Organization
Contact information
Practice address
478 S SANDUSKY ST, DELAWARE, OH 43015-2623
(740) 369-8741
(740) 363-8359
Mailing address
PO BOX 427, SHARON CENTER, OH 44274-0427
(330) 239-4474
(330) 239-4479
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1413N
OH
Other
Enumeration date
10/07/2013
Last updated
10/07/2013
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