GRACEWORKS ENHANCED LIVING NPI 1205900917

NPI Information

NPI: 1205900917
Provider Name: GRACEWORKS ENHANCED LIVING

Doing Business As: SPRINGDALE HOME

Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization
Address:
11651 WALNUT ST
CINCINNATI, OH
ZIP 45246
Phone: (513) 671-2654
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GRACEWORKS ENHANCED LIVING is an intermediate care facility mentally retarded in Cincinnati, OH. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. GRACEWORKS ENHANCED LIVING NPI is 1205900917. The provider is registered as an organization entity type.
The provider Is Doing Business As Springdale Home.

The provider's business location address is:

11651 WALNUT ST
CINCINNATI, OH
ZIP 45246-046
Phone: (513) 671-2654
Fax: (513) 671-1293

The provider's authorized official is Michael W Allen .
The authorized official title is Vice President, Finance & Facilitie and has the following contact phone number (937) 436-6885.

The enumeration date for this NPI number is 11/17/2006 and was last updated on 12/23/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities		3112143	OHIO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	2032740	MEDICAID	OHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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