MEDICARE: SOUTHBROOK HEALTH CARE CENTER, 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	6219	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	:	1932198710
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHBROOK HEALTH CARE CENTER, INC.

Provider Business Mailing Address
First Line	:	2299 SOUTH YELLOW SPRINGS STREET
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45506
Country	:	US
Telephone Number	:	937-322-3436
Fax Number	:	937-322-2470

Provider Business Practice Location Address
First Line	:	2299 S YELLOW SPRINGS ST
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45506-3221
Country	:	US
Telephone Number	:	937-322-3436
Fax Number	:	937-322-2470

Authorized Official
Title or Position	:	OWNER
Name	:	MR. HAROLD SOSNA
Credential	:
Telephone Number	:	513-561-4105

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	08/14/2020

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