Healthcare Provider Details

I. General information

NPI: 1629569439
Provider Name (Legal Business Name): SPRINGFIELD SNF, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 VILLA RD
SPRINGFIELD OH
45503-1761
US

IV. Provider business mailing address

2000 VILLA RD
SPRINGFIELD OH
45503-1761
US

V. Phone/Fax

Practice location:
  • Phone: 937-399-7009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DAN DAMICO
Title or Position: COO
Credential:
Phone: 330-856-4232