MEDICARE: COLERAIN CARE CENTER OPCO 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	:	1518899582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLERAIN CARE CENTER OPCO LLC

Provider Business Mailing Address
First Line	:	5910 LANDERBROOK DR STE 150
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-6506
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8440 LIVINGSTON RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-3731
Country	:	US
Telephone Number	:	216-412-2300
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	JEFFREY DEGYANSKY
Credential	:
Telephone Number	:	330-620-7828

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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