Provider Demographics
NPI:1093813016
Name:ELMWOOD OF FREMONT, LTD.
Entity Type:Organization
Organization Name:ELMWOOD OF FREMONT, LTD.
Other - Org Name:ELMWOOD ASSISTED LIVING OF FREMONT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-332-3378
Mailing Address - Street 1:441 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:GREEN SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:44836-9689
Mailing Address - Country:US
Mailing Address - Phone:419-332-3378
Mailing Address - Fax:419-639-2519
Practice Address - Street 1:1545 FANGBONER RD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-1128
Practice Address - Country:US
Practice Address - Phone:419-332-6533
Practice Address - Fax:419-332-6535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
OH5391310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2173ROtherODH PROVIDER #
OH5391OtherRCF LICENSE #
OH0110265Medicaid
OH2173NOtherODH LICENSE NUMBER FOR SNF