Organization
EW ALF LLC
Active
Other names
Eaglewood Village
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE E WERTHEIM (MANAGER)
(917) 919-7204
Entity
Organization
Contact information
Practice address
3001 MIDDLE URBANA RD, SPRINGFIELD, OH 45502-9284
(937) 399-7195
(937) 390-8253
Mailing address
3001 MIDDLE URBANA RD, SPRINGFIELD, OH 45502-9284
(937) 399-7195
(937) 390-8253
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TBD
TBD
—
Enumeration date
07/16/2015
Last updated
07/16/2015
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