Healthcare Provider Details

I. General information

NPI: 1982955357
Provider Name (Legal Business Name): BARNESVILLE HEALTHCARE AND REHAB CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2012
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 CARRIE AVE
BARNESVILLE OH
43713-1317
US

IV. Provider business mailing address

2711 W HOWARD ST
CHICAGO IL
60645-1303
US

V. Phone/Fax

Practice location:
  • Phone: 740-425-3648
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MATT GOTTER
Title or Position: VP OF REVENUE CYCLE MANAGEMENT
Credential:
Phone: 773-338-4400