MEDICARE: ADCARE HEALTH SYSTEMS, 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	2370358	OH
2	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1497720668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADCARE HEALTH SYSTEMS, INC.

Provider Business Mailing Address
First Line	:	75 MOTE DR
Second Line	:
City	:	COVINGTON
State	:	OH
Zip	:	45318-1245
Country	:	US
Telephone Number	:	937-473-2075
Fax Number	:	937-473-2963

Provider Business Practice Location Address
First Line	:	75 MOTE DR
Second Line	:
City	:	COVINGTON
State	:	OH
Zip	:	45318-1245
Country	:	US
Telephone Number	:	937-473-2075
Fax Number	:	937-473-2963

Authorized Official
Title or Position	:	COO
Name	:	DAVID RUBENSTEIN
Credential	:
Telephone Number	:	678-869-5116

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	07/29/2014

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