Healthcare Provider Details

I. General information

NPI: 1336114404
Provider Name (Legal Business Name): HEARTH & CARE OF GREENFIELD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 S WASHINGTON ST
GREENFIELD OH
45123-1467
US

IV. Provider business mailing address

238 S WASHINGTON ST
GREENFIELD OH
45123-1467
US

V. Phone/Fax

Practice location:
  • Phone: 937-981-3349
  • Fax: 937-981-2859
Mailing address:
  • Phone: 937-981-3349
  • Fax: 937-981-2859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2104912
License Number StateOH

VIII. Authorized Official

Name: DAVID RUBENSTEIN
Title or Position: COO
Credential:
Phone: 678-869-5116