MEDICARE: BEECHWOOD HOME

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	510646896	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
2	000000295145	OTHER		ANTHEM BC / BS

General Provider Information

NPI Number	:	1306849245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEECHWOOD HOME

Provider Business Mailing Address
First Line	:	2140 POGUE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-3234
Country	:	US
Telephone Number	:	513-321-9294
Fax Number	:	513-321-4664

Provider Business Practice Location Address
First Line	:	2140 POGUE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-3234
Country	:	US
Telephone Number	:	513-321-9294
Fax Number	:	513-321-4664

Authorized Official
Title or Position	:	CEO
Name	:	MRS. PATRICIA CLARK
Credential	:
Telephone Number	:	513-321-9294

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	01/13/2012

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Directions to “BEECHWOOD HOME ” Practice Location

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