Healthcare Provider Details

I. General information

NPI: 1114107596
Provider Name (Legal Business Name): CARRIAGE INN OF TROTWOOD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 SHILOH SPRINGS RD
TROTWOOD OH
45426-2260
US

IV. Provider business mailing address

5020 PHILADELPHIA DR
DAYTON OH
45415-3653
US

V. Phone/Fax

Practice location:
  • Phone: 937-854-1180
  • Fax:
Mailing address:
  • Phone: 937-277-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1970N
License Number StateOH

VIII. Authorized Official

Name: MR. KEN BERNSEN
Title or Position: PRESIDENT
Credential:
Phone: 937-277-0505