Provider Demographics
NPI:1992006985
Name:BROOKDALE SENIOR LIVING COMMUNITIES INC
Entity Type:Organization
Organization Name:BROOKDALE SENIOR LIVING COMMUNITIES INC
Other - Org Name:STERLING HOUSE BEAVERCREEK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-PRESIDENT/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:RIJOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-977-3700
Mailing Address - Street 1:3839 INDIAN RIPPLE RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3468
Mailing Address - Country:US
Mailing Address - Phone:937-431-0455
Mailing Address - Fax:937-431-0435
Practice Address - Street 1:3839 INDIAN RIPPLE RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-3468
Practice Address - Country:US
Practice Address - Phone:937-431-0455
Practice Address - Fax:937-431-0435
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKDALE SENIOR LIVING INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2196R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAPPLIED FOROtherMEDICAID WAIVER