MEDICARE: PATASKALA LAND CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	4282	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134103617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATASKALA LAND CORPORATION

Provider Business Mailing Address
First Line	:	7265 KENWOOD RD
Second Line	:	SUITE 300
City	:	CINCINNATI
State	:	OH
Zip	:	45236-4400
Country	:	US
Telephone Number	:	513-793-8804
Fax Number	:	513-793-8799

Provider Business Practice Location Address
First Line	:	144 E BROAD ST
Second Line	:
City	:	PATASKALA
State	:	OH
Zip	:	43062-7536
Country	:	US
Telephone Number	:	740-927-9888
Fax Number	:	740-927-2454

Authorized Official
Title or Position	:	EXEC. VICE PRESIDENT
Name	:	MICHAEL SCHARFENBERGER
Credential	:	LNHA
Telephone Number	:	513-793-8804

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	11/13/2007

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Directions to “PATASKALA LAND CORPORATION ” Practice Location

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