Provider Demographics
NPI:1932207446
Name:ELMWOOD CENTERS INC
Entity Type:Organization
Organization Name:ELMWOOD CENTERS INC
Other - Org Name:ELMPARK GROUP HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:K
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:419-639-2581
Mailing Address - Street 1:430 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:GREEN SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:44836-9601
Mailing Address - Country:US
Mailing Address - Phone:419-639-2581
Mailing Address - Fax:419-639-2519
Practice Address - Street 1:504 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-1901
Practice Address - Country:US
Practice Address - Phone:419-639-2581
Practice Address - Fax:419-639-2519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7210075315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH36G272Medicaid
OH7210075OtherMRDD LICENSURE #