Provider Demographics
NPI:1124906581
Name:OTTERBEIN LEBANON RETIREMENT LIVING COMMUNITY
Entity type:Organization
Organization Name:OTTERBEIN LEBANON RETIREMENT LIVING COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:513-933-5418
Mailing Address - Street 1:3855 LOWER MARKET ST STE 300
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-7654
Mailing Address - Country:US
Mailing Address - Phone:513-933-5401
Mailing Address - Fax:
Practice Address - Street 1:585 N STATE ROUTE 741
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-3313
Practice Address - Country:US
Practice Address - Phone:513-696-8567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OTTERBEIN LEBANON RETIREMENT LIVING COMMUNITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care