Healthcare Provider Details

I. General information

NPI: 1528042736
Provider Name (Legal Business Name): CHS - CLERMONT NCC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

934 STATE ROUTE 28
MILFORD OH
45150-1912
US

IV. Provider business mailing address

782 W ORANGE RD
DELAWARE OH
43015-8922
US

V. Phone/Fax

Practice location:
  • Phone: 513-831-1770
  • Fax: 513-831-5184
Mailing address:
  • Phone: 330-204-1040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1307N
License Number StateOH

VIII. Authorized Official

Name: ROBERT SPEELMAN
Title or Position: PRESIDENT
Credential:
Phone: 330-204-1040