Provider Demographics
NPI:1376792440
Name:THE CENTRUM AT WILLOW BROOK , INC
Entity Type:Organization
Organization Name:THE CENTRUM AT WILLOW BROOK , INC
Other - Org Name:THE CENTRUM ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CENTRUM MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:ELEAK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:740-368-4696
Mailing Address - Street 1:100 WILLOW BROOK WAY SO.
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-3249
Mailing Address - Country:US
Mailing Address - Phone:740-369-0048
Mailing Address - Fax:740-369-7034
Practice Address - Street 1:100 WILLOW BROOK WAY SO.
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-3249
Practice Address - Country:US
Practice Address - Phone:740-369-0048
Practice Address - Fax:740-369-7034
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILLOW BROOK CHRISTIAN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5176310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility