Provider Demographics
NPI:1598131476
Name:OTTERBEIN BATAVIA, LLC
Entity Type:Organization
Organization Name:OTTERBEIN BATAVIA, LLC
Other - Org Name:OTTERBEIN UNION TOWNSHIP
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO & TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CHRIS
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:513-933-5418
Mailing Address - Street 1:580 N STATE ROUTE 741
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-8839
Mailing Address - Country:US
Mailing Address - Phone:513-933-5401
Mailing Address - Fax:
Practice Address - Street 1:1114 NEIGHBORHOOD DRIVE
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103-2874
Practice Address - Country:US
Practice Address - Phone:513-933-5401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OTTERBEIN HOMES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-14
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2721N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0145822Medicaid
OH0145822Medicaid