MEDICARE: EASTGATE HEALTH CARE CENTER, 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	1848	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	:	1770581878
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTGATE HEALTH CARE CENTER, LLC

Provider Business Mailing Address
First Line	:	390 WARDS CORNER RD
Second Line	:
City	:	LOVELAND
State	:	OH
Zip	:	45140-6969
Country	:	US
Telephone Number	:	513-943-4000
Fax Number	:	513-943-4240

Provider Business Practice Location Address
First Line	:	4400 GLEN ESTE WITHAMSVILLE RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45245-1306
Country	:	US
Telephone Number	:	513-752-3710
Fax Number	:	513-752-7603

Authorized Official
Title or Position	:	CFO
Name	:	MR. DAVID EPPERS
Credential	:	CPA
Telephone Number	:	513-707-1537

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	01/16/2014

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