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
1	310400000X	Assisted Living Facility	5285	OH
2	314000000X	Skilled Nursing Facility	5027	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5027	OTHER	OH	SNF LICENSE #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	5285	OTHER	OH	RES. CARE FACILITY LIC #

General Provider Information

NPI Number	:	1639162316
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEACONESS LONG TERM CARE OF OHIO, INC.

Provider Business Mailing Address
First Line	:	615 ELSINORE PL STE 901
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-1459
Country	:	US
Telephone Number	:	513-487-3600
Fax Number	:	513-475-4325

Provider Business Practice Location Address
First Line	:	5640 COX SMITH RD
Second Line	:
City	:	MASON
State	:	OH
Zip	:	45040-2210
Country	:	US
Telephone Number	:	513-398-2881
Fax Number	:	513-398-2118

Authorized Official
Title or Position	:	COO
Name	:	JOHN MURTA
Credential	:
Telephone Number	:	513-559-2265

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	01/27/2020

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Directions to “DEACONESS LONG TERM CARE OF OHIO, INC. ” Practice Location

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