MEDICARE: BUCKEYE FOREST AT MADEIRA LLC

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

General Provider Information

NPI Number	:	1962160077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUCKEYE FOREST AT MADEIRA LLC

Provider Business Mailing Address
First Line	:	5970 KENWOOD RD
Second Line	:
City	:	MADEIRA
State	:	OH
Zip	:	45243-2930
Country	:	US
Telephone Number	:	513-561-4111
Fax Number	:

Provider Business Practice Location Address
First Line	:	5970 KENWOOD RD
Second Line	:
City	:	MADEIRA
State	:	OH
Zip	:	45243-2930
Country	:	US
Telephone Number	:	513-561-4111
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ABBA STEIN
Credential	:
Telephone Number	:	513-561-4111

Provider Enumeration Date	:	12/06/2021
Last Update Date	:	12/06/2021

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Directions to “BUCKEYE FOREST AT MADEIRA LLC ” Practice Location

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