Provider Demographics
NPI:1811033756
Name:THE LODGE RETIREMENT COMMUNITY
Entity Type:Organization
Organization Name:THE LODGE RETIREMENT COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAWNYA
Authorized Official - Middle Name:W
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:513-583-3291
Mailing Address - Street 1:12050 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2003
Mailing Address - Country:US
Mailing Address - Phone:513-683-9966
Mailing Address - Fax:513-583-3295
Practice Address - Street 1:12050 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2003
Practice Address - Country:US
Practice Address - Phone:513-683-9966
Practice Address - Fax:513-583-3295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6378310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility