Healthcare Provider Details

I. General information

NPI: 1699053595
Provider Name (Legal Business Name): SCOTTS HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2011
Last Update Date: 01/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81330 SLAB CAMP RD
CADIZ OH
43907-9534
US

IV. Provider business mailing address

81330 SLAB CAMP RD
CADIZ OH
43907-9534
US

V. Phone/Fax

Practice location:
  • Phone: 740-942-3532
  • Fax: 740-942-3532
Mailing address:
  • Phone: 740-942-3532
  • Fax: 740-942-3532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberNP04382
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DEBORAH SCOTT
Title or Position: NURSE PRACTITIONER
Credential: CNP
Phone: 740-942-3532