Healthcare Provider Details

I. General information

NPI: 1518211366
Provider Name (Legal Business Name): CHS OF KETTERING OPERATING COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2012
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 W DOROTHY LN
DAYTON OH
45409-1305
US

IV. Provider business mailing address

5020 PHILADELPHIA DR
DAYTON OH
45415-3653
US

V. Phone/Fax

Practice location:
  • Phone: 937-293-1152
  • Fax: 937-298-9465
Mailing address:
  • Phone: 937-277-0505
  • Fax: 937-277-4234

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: KENNETH J BERNSEN
Title or Position: PRESIDENT
Credential:
Phone: 937-277-0505