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General NPI Number Information
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NPI Number | 1912995176
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Entity Type | Organization
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Legal Business Name | EDGERTON LONG TERM CARE, INC.
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 328 W VINE ST
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City | EDGERTON
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State | OH
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Zip | 43517-9600
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Country | US
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Telephone | 419-298-2321
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Fax | 419-298-2476
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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 | EXECUTIVE VICE PRESIDENT
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Name | MR. MICHAEL J 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 | 3591
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License Number State | OH
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