Healthcare Provider Details

I. General information

NPI: 1215343058
Provider Name (Legal Business Name): LP COSHOCTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2014
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S WHITEWOMAN ST
COSHOCTON OH
43812-1068
US

IV. Provider business mailing address

12201 BLUEGRASS PKWY
LOUISVILLE KY
40299-2361
US

V. Phone/Fax

Practice location:
  • Phone: 740-622-1220
  • Fax: 740-622-3684
Mailing address:
  • Phone: 502-804-3711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JOHN HARRISON
Title or Position: CFO
Credential:
Phone: 502-568-7800