MEDICARE: D.R.L. REAL ESTATE, LTD.

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	NH-016880-NH	OH

General Provider Information

NPI Number	:	1801042965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D.R.L. REAL ESTATE, LTD.

Provider Business Mailing Address
First Line	:	5501 VERULAM AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45213-2417
Country	:	US
Telephone Number	:	513-631-1310
Fax Number	:	513-631-1328

Provider Business Practice Location Address
First Line	:	5501 VERULAM AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45213-2417
Country	:	US
Telephone Number	:	513-631-1310
Fax Number	:	513-631-1328

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. DAVID R. LIIPSON
Credential	:
Telephone Number	:	513-631-1310

Provider Enumeration Date	:	08/08/2008
Last Update Date	:	08/08/2008

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