Provider Demographics
NPI:1245235845
Name:EVANGELICAL RETIREMENT VILLAGES,INC. OF DAYTON DBA FRIENDSHIP VILLAGE
Entity Type:Organization
Organization Name:EVANGELICAL RETIREMENT VILLAGES,INC. OF DAYTON DBA FRIENDSHIP VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:D
Authorized Official - Last Name:CRANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-837-5581
Mailing Address - Street 1:5790 DENLINGER RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45426-1838
Mailing Address - Country:US
Mailing Address - Phone:937-838-5581
Mailing Address - Fax:937-854-8203
Practice Address - Street 1:5790 DENLINGER RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45426-1838
Practice Address - Country:US
Practice Address - Phone:937-838-5581
Practice Address - Fax:937-854-8203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2380314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility