Provider Demographics
NPI:1629052139
Name:ELIZABETH SCOTT COMMUNITY, INC.
Entity Type:Organization
Organization Name:ELIZABETH SCOTT COMMUNITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:DENNIE
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:419-724-5156
Mailing Address - Street 1:2720 ALBON RD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-9752
Mailing Address - Country:US
Mailing Address - Phone:419-865-3002
Mailing Address - Fax:419-865-1283
Practice Address - Street 1:2720 ALBON RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-9752
Practice Address - Country:US
Practice Address - Phone:419-865-3002
Practice Address - Fax:419-865-1283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0184314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2440424Medicaid
OH2440424Medicaid