MEDICARE: CARRIAGE INN OF TROTWOOD, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	1970N	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114107596
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARRIAGE INN OF TROTWOOD, INC

Provider Business Mailing Address
First Line	:	5020 PHILADELPHIA DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45415-3653
Country	:	US
Telephone Number	:	937-277-0505
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 SHILOH SPRINGS RD
Second Line	:
City	:	TROTWOOD
State	:	OH
Zip	:	45426-2260
Country	:	US
Telephone Number	:	937-854-1180
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KEN BERNSEN
Credential	:
Telephone Number	:	937-277-0505

Provider Enumeration Date	:	11/14/2007
Last Update Date	:	12/17/2007

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