Provider Demographics
NPI:1346210515
Name:WILLOW BROOK CHRISTIAN SERVICES
Entity Type:Organization
Organization Name:WILLOW BROOK CHRISTIAN SERVICES
Other - Org Name:WILLOW BROOK CHRISTIAN HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MARTINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-368-4621
Mailing Address - Street 1:100 WILLOW BROOK WAY S
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015
Mailing Address - Country:US
Mailing Address - Phone:740-369-0048
Mailing Address - Fax:740-368-4630
Practice Address - Street 1:55 LAZELLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-1419
Practice Address - Country:US
Practice Address - Phone:614-885-3300
Practice Address - Fax:614-885-8476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1315N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2492388Medicaid
OH365988Medicare ID - Type Unspecified