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General NPI Number Information
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NPI Number | 1457848210
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Entity Type | Organization
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Legal Business Name | CT OHIO PORTSMOUTH LLC
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Dates
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Enumeration Date | 04/17/2018
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 727 8TH ST
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City | PORTSMOUTH
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State | OH
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Zip | 45662-4020
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Country | US
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Telephone | 740-354-8150
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Fax | 740-353-1826
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Provider Business Mailing Address
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Address Line | 727 8TH ST
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City | PORTSMOUTH
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State | OH
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Zip | 45662-4020
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Country | US
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Telephone | 740-354-8150
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. RAFAEL A MOERMAN
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Credential |
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Telephone | 516-865-1500
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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 |
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License Number State | OH
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