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General NPI Number Information
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NPI Number | 1639162316
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Entity Type | Organization
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Legal Business Name | DEACONESS LONG TERM CARE OF OHIO, INC.
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 01/27/2020
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Provider Practice Location Address
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Address Line | 5640 COX SMITH RD
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City | MASON
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State | OH
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Zip | 45040-2210
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Country | US
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Telephone | 513-398-2881
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Fax | 513-398-2118
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Provider Business Mailing Address
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Address Line | 615 ELSINORE PL STE 901
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City | CINCINNATI
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State | OH
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Zip | 45202-1459
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Country | US
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Telephone | 513-487-3600
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Fax | 513-475-4325
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Authorized Official
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Title or Position | COO
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Name | JOHN MURTA
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Credential |
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Telephone | 513-559-2265
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 5285
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 5027
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License Number State | OH
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