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General NPI Number Information
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NPI Number | 1134103617
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Entity Type | Organization
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Legal Business Name | PATASKALA LAND CORPORATION
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Dates
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Enumeration Date | 11/30/2005
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Last Update Date | 11/13/2007
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Provider Practice Location Address
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Address Line | 144 E BROAD ST
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City | PATASKALA
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State | OH
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Zip | 43062-7536
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Country | US
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Telephone | 740-927-9888
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Fax | 740-927-2454
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Provider Business Mailing Address
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Address Line | 7265 KENWOOD RD SUITE 300
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City | CINCINNATI
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State | OH
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Zip | 45236-4400
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Country | US
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Telephone | 513-793-8804
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Fax | 513-793-8799
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Authorized Official
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Title or Position | EXEC. VICE PRESIDENT
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Name | MICHAEL SCHARFENBERGER
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Credential | LNHA
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Telephone | 513-793-8804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 4282
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License Number State | OH
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Legacy Identifiers
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Identifier #1
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Identifier Code | 0801332
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Identifier Type | MEDICAID
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Identifier State | OH
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Identifier Issuer |
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 0801332
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Identifier Type | MEDICAID
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Identifier State | OH
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Identifier Issuer |
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