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NPI Code Detail

MEDICARE: DEACONESS LONG TERM CARE OF OHIO, INC.

MEDICARE: DEACONESS LONG TERM CARE OF OHIO, INC.
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
1314000000XSkilled Nursing Facility030087MO

Other Identifiers

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

General Provider Information

NPI Number : 1588658900
Entity Type Code : Organization
Provider Name (Legal Business Name) : DEACONESS LONG TERM CARE OF OHIO, INC.
Provider Business Mailing Address
First Line : 440 LAFAYETTE AVE
Second Line : SUITE 400
City : CINCINNATI
State : OH
Zip : 45220-1022
Country : US
Telephone Number : 513-487-3600
Fax Number : 513-487-3653
Provider Business Practice Location Address
First Line : 631 W MAIN ST
Second Line :
City : BUFFALO
State : MO
Zip : 65622-7496
Country : US
Telephone Number : 417-345-5422
Fax Number : 417-345-5424
Authorized Official
Title or Position : CFO
Name : CARLA BROOKS
Credential :
Telephone Number : 513-487-3600
Provider Enumeration Date : 08/31/2005
Last Update Date : 08/29/2008

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