Provider Demographics
NPI:1558736108
Name:INN AT WINCHESTER TRAIL MGT COMPANY LLC
Entity Type:Organization
Organization Name:INN AT WINCHESTER TRAIL MGT COMPANY LLC
Other - Org Name:INN AT WINCHESTER TRAIL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDI
Authorized Official - Middle Name:L
Authorized Official - Last Name:HANEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-816-5009
Mailing Address - Street 1:6401 WINCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-2057
Mailing Address - Country:US
Mailing Address - Phone:614-829-6388
Mailing Address - Fax:
Practice Address - Street 1:6401 WINCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-2057
Practice Address - Country:US
Practice Address - Phone:614-829-6388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHR2704310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility