Provider Demographics
NPI:1346233038
Name:OTTAWA RETIREMENT VILLAGE, INC.
Entity Type:Organization
Organization Name:OTTAWA RETIREMENT VILLAGE, INC.
Other - Org Name:OTTAWA RETIREMENT VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:F
Authorized Official - Last Name:RAUPACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-487-3600
Mailing Address - Street 1:330 STRAIGHT ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1064
Mailing Address - Country:US
Mailing Address - Phone:513-487-3600
Mailing Address - Fax:513-487-3612
Practice Address - Street 1:1100 W 15TH ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-3953
Practice Address - Country:US
Practice Address - Phone:785-242-5399
Practice Address - Fax:785-242-6063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSNO30005314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100110980BOtherHCBS #
KS100110980AMedicaid
KSNO30005OtherADULT CARE HOME LICENSE
KS175332Medicare Oscar/Certification