Healthcare Provider Details

I. General information

NPI: 1750468237
Provider Name (Legal Business Name): SPRINGFIELD HEALTH CARE OPERATING COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 E. MCCREIGHT AVE.
SPRINGFIELD OH
45503
US

IV. Provider business mailing address

2457 BROADWAY AVENUE
OAKWOOD VILLAGE OH
44146
US

V. Phone/Fax

Practice location:
  • Phone: 937-399-8311
  • Fax: 937-399-7370
Mailing address:
  • Phone: 440-439-7976
  • Fax: 440-232-7113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number1044N
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1044N
License Number StateOH

VIII. Authorized Official

Name: MR. THOMAS E. BARTLEBAUGH
Title or Position: CO-MANAGING MEMBER
Credential:
Phone: 330-425-4696