Healthcare Provider Details

I. General information

NPI: 1104905173
Provider Name (Legal Business Name): DEERFIELD NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 HIGH ST.
FRANKFORT OH
45628-0312
US

IV. Provider business mailing address

PO BOX 312
FRANKFORT OH
45628-0312
US

V. Phone/Fax

Practice location:
  • Phone: 740-998-4779
  • Fax: 740-998-4801
Mailing address:
  • Phone: 740-998-4779
  • Fax: 740-998-4801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number4494
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2510N
License Number StateOH

VIII. Authorized Official

Name: DOLORES A. HICKS
Title or Position: PRESIDENT
Credential:
Phone: 740-998-4777