Basic Information
| Provider Information | |||||||||
| NPI: | 1487052940 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WC-GROVE CITY OPS, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CARRIAGE COURT OF GROVE CITY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2320 SONORA DR | ||||||||
| Address2: | |||||||||
| City: | GROVE CITY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431232423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148718000 | ||||||||
| FaxNumber: | 6148718000 | ||||||||
| Practice Location | |||||||||
| Address1: | 2320 SONORA DR | ||||||||
| Address2: | |||||||||
| City: | GROVE CITY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 431232423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148718000 | ||||||||
| FaxNumber: | 6148718000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2014 | ||||||||
| LastUpdateDate: | 12/16/2014 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MOENING | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6148718000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | 1984R | OH | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.