Healthcare Provider Details

I. General information

NPI: 1912995176
Provider Name (Legal Business Name): EDGERTON LONG TERM CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 W VINE ST
EDGERTON OH
43517-9600
US

IV. Provider business mailing address

7265 KENWOOD RD SUITE 300
CINCINNATI OH
45236-4400
US

V. Phone/Fax

Practice location:
  • Phone: 419-298-2321
  • Fax: 419-298-2476
Mailing address:
  • Phone: 513-793-8804
  • Fax: 513-793-8799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3591
License Number StateOH

VIII. Authorized Official

Name: MR. MICHAEL J SCHARFENBERGER
Title or Position: EXECUTIVE VICE PRESIDENT
Credential: LNHA
Phone: 513-793-8804