Provider Demographics
NPI:1568522092
Name:ECHOING HILLS VILLAGE, INC.
Entity Type:Organization
Organization Name:ECHOING HILLS VILLAGE, INC.
Other - Org Name:ECHOING WOODS RESIDENTIAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-327-2311
Mailing Address - Street 1:36272 COUNTY ROAD 79
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:OH
Mailing Address - Zip Code:43844-9770
Mailing Address - Country:US
Mailing Address - Phone:740-327-2311
Mailing Address - Fax:740-327-6371
Practice Address - Street 1:5455 SALEM BEND DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45426-1609
Practice Address - Country:US
Practice Address - Phone:937-854-5151
Practice Address - Fax:937-854-5153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5710225315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0455994Medicaid
OH9069OtherOHIO DEPT OF HEALTH ID #
OH0455994Medicaid