=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083179147
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCV HEALTH CARE FACILITIES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2019
-----------------------------------------------------
Last Update Date | 02/04/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 411 WESTERN ROW RD
-----------------------------------------------------
City | MASON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45040-1438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-800-1674
-----------------------------------------------------
Fax | 513-931-5311
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 411 WESTERN ROW RD
-----------------------------------------------------
City | MASON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45040-1438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-800-1674
-----------------------------------------------------
Fax | 513-931-5311
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | VICKIE L. BRASHEAR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 513-800-1674
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------