Provider Demographics
NPI:1477144434
Name:MIDDLETOWN POST ACUTE, LLC
Entity Type:Organization
Organization Name:MIDDLETOWN POST ACUTE, LLC
Other - Org Name:WILLOW KNOLL POST ACUTE AND SENIOR LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-447-9829
Mailing Address - Street 1:140 N UNION AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2956
Mailing Address - Country:US
Mailing Address - Phone:385-381-9419
Mailing Address - Fax:
Practice Address - Street 1:4400 VANNEST AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-2770
Practice Address - Country:US
Practice Address - Phone:513-422-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-01
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility