Provider Demographics
NPI:1568456614
Name:DELANEY CREEK LODGE, LLP
Entity Type:Organization
Organization Name:DELANEY CREEK LODGE, LLP
Other - Org Name:DELANEY CREEK LODGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO - DEACONESS LONG TERM CARE, INC
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-487-3600
Mailing Address - Street 1:440 LAFAYETTE AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-1022
Mailing Address - Country:US
Mailing Address - Phone:513-487-3600
Mailing Address - Fax:513-487-3638
Practice Address - Street 1:320 S LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-0809
Practice Address - Country:US
Practice Address - Phone:813-655-8858
Practice Address - Fax:813-655-1079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL9582310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL9582OtherASSISTED LIVING LICENSE #