MEDICARE: MADEIRA HEALTHCARE LLC

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

General Provider Information

NPI Number	:	1265914204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MADEIRA HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	544 ENTERPRISE DR
Second Line	:
City	:	LEWIS CENTER
State	:	OH
Zip	:	43035-9704
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5970 KENWOOD RD
Second Line	:
City	:	MADEIRA
State	:	OH
Zip	:	45243-2930
Country	:	US
Telephone Number	:	513-561-4111
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	PAUL BERGSTEN
Credential	:
Telephone Number	:	937-825-6622

Provider Enumeration Date	:	09/06/2018
Last Update Date	:	09/06/2018

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Directions to “MADEIRA HEALTHCARE LLC ” Practice Location

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