MEDICARE: CARESERVE 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	0066N	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	:	1235126574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARESERVE INC

Provider Business Mailing Address
First Line	:	4114 N STATE ROUTE 376 NW
Second Line	:
City	:	MC CONNELSVILLE
State	:	OH
Zip	:	43756-9145
Country	:	US
Telephone Number	:	740-962-3761
Fax Number	:	740-962-3001

Provider Business Practice Location Address
First Line	:	4114 N STATE ROUTE 376 NW
Second Line	:
City	:	MC CONNELSVILLE
State	:	OH
Zip	:	43756-9145
Country	:	US
Telephone Number	:	740-962-3761
Fax Number	:	740-962-3001

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. DAVID A DAVIS
Credential	:	R.N., LNHA
Telephone Number	:	740-962-3761

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	08/22/2020

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Directions to “CARESERVE INC ” Practice Location

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