Provider Demographics
NPI:1861633547
Name:BCC ONTARIO OPERATIONS LLC
Entity Type:Organization
Organization Name:BCC ONTARIO OPERATIONS LLC
Other - Org Name:ELMCROFT OF ONTARIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:MULLOY
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:502-753-6000
Mailing Address - Street 1:9510 ORMSBY STATION RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4081
Mailing Address - Country:US
Mailing Address - Phone:502-753-6000
Mailing Address - Fax:
Practice Address - Street 1:2010 WALKER LAKE RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-1412
Practice Address - Country:US
Practice Address - Phone:419-747-1119
Practice Address - Fax:419-747-4887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2205R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility