Healthcare Provider Details

I. General information

NPI: 1902472236
Provider Name (Legal Business Name): DIVERSICARE OF BRADFORD PLACE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 05/27/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 MILLVILLE AVE
HAMILTON OH
45013-3961
US

IV. Provider business mailing address

1302 MILLVILLE AVE
HAMILTON OH
45013-3961
US

V. Phone/Fax

Practice location:
  • Phone: 513-867-4100
  • Fax: 513-867-1415
Mailing address:
  • Phone: 513-867-4100
  • Fax: 513-867-1415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: JAMES R. MCKNIGHT JR.
Title or Position: CEO
Credential:
Phone: 615-771-7575