MEDICARE: CHS - CLERMONT NCC, 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	1307N	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	:	1528042736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHS - CLERMONT NCC, INC.

Provider Business Mailing Address
First Line	:	782 W ORANGE RD
Second Line	:
City	:	DELAWARE
State	:	OH
Zip	:	43015-8922
Country	:	US
Telephone Number	:	330-204-1040
Fax Number	:

Provider Business Practice Location Address
First Line	:	934 STATE ROUTE 28
Second Line	:
City	:	MILFORD
State	:	OH
Zip	:	45150-1912
Country	:	US
Telephone Number	:	513-831-1770
Fax Number	:	513-831-5184

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT SPEELMAN
Credential	:
Telephone Number	:	330-204-1040

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	06/12/2014

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