Provider Demographics
NPI:1821106576
Name:MEADOW WOOD CARE CENTER
Entity Type:Organization
Organization Name:MEADOW WOOD CARE CENTER
Other - Org Name:MEADOW WOOD NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:CROUT
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:937-378-3727
Mailing Address - Street 1:61 STEPHENS AVE
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45121-9509
Mailing Address - Country:US
Mailing Address - Phone:937-378-3727
Mailing Address - Fax:937-378-3733
Practice Address - Street 1:61 STEPHENS AVE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:OH
Practice Address - Zip Code:45121-9509
Practice Address - Country:US
Practice Address - Phone:937-378-3727
Practice Address - Fax:937-378-3733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3566314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2326245Medicaid
OH365231Medicare ID - Type Unspecified