Provider Demographics
NPI:1932238854
Name:DAYTON SENIOR CARE LLC
Entity Type:Organization
Organization Name:DAYTON SENIOR CARE LLC
Other - Org Name:FRIENDSHIP VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-584-6755
Mailing Address - Street 1:5790 DENLINGER RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45426-1838
Mailing Address - Country:US
Mailing Address - Phone:937-837-5581
Mailing Address - Fax:937-854-8203
Practice Address - Street 1:5790 DENLINGER RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45426-1838
Practice Address - Country:US
Practice Address - Phone:937-837-5581
Practice Address - Fax:937-854-8203
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAYTON SENIOR CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-05
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1578314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000501860OtherANTHEM INSURANCE
OH2686820Medicaid
OH000000501860OtherANTHEM INSURANCE