Provider Demographics
NPI:1124184924
Name:THE CHAMPAIGN COUNTY BOARD OF COMMISSIONERS
Entity Type:Organization
Organization Name:THE CHAMPAIGN COUNTY BOARD OF COMMISSIONERS
Other - Org Name:THE WELLINGTON NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:937-653-5291
Mailing Address - Street 1:2380 S US HIGHWAY 68
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:OH
Mailing Address - Zip Code:43078-9470
Mailing Address - Country:US
Mailing Address - Phone:937-653-5291
Mailing Address - Fax:937-653-3885
Practice Address - Street 1:2380 S US HIGHWAY 68
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:OH
Practice Address - Zip Code:43078-9470
Practice Address - Country:US
Practice Address - Phone:937-653-5291
Practice Address - Fax:937-653-3885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0250400Medicaid
OH2684126Medicaid
OH2655532Medicaid
OH0566258Medicaid
OH0566258Medicaid
OH2684126Medicaid