MEDICARE: AHF CENTRAL STATES, 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	17940	TN

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649254608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AHF CENTRAL STATES, INC

Provider Business Mailing Address
First Line	:	4248 TULLER RD
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43017-5025
Country	:	US
Telephone Number	:	614-760-7352
Fax Number	:	614-760-7356

Provider Business Practice Location Address
First Line	:	1710 BELCOURT AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37212-3717
Country	:	US
Telephone Number	:	615-383-3570
Fax Number	:	615-460-7778

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MARK T HAEMMERLE
Credential	:	CPA, INACTIVE
Telephone Number	:	614-760-7352

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	08/22/2020

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