MEDICARE: ST. JOSEPH CARE CENTER

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	313M00000X	Nursing Facility/Intermediate Care Facility	5432	OH
2	310400000X	Assisted Living Facility	4986	OH
3	314000000X	Skilled Nursing Facility	5432	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	:	1952300113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. JOSEPH CARE CENTER

Provider Business Mailing Address
First Line	:	2308 RENO DR
Second Line	:
City	:	LOUISVILLE
State	:	OH
Zip	:	44641-9083
Country	:	US
Telephone Number	:	330-875-5562
Fax Number	:	330-875-8947

Provider Business Practice Location Address
First Line	:	2308 RENO DR
Second Line	:
City	:	LOUISVILLE
State	:	OH
Zip	:	44641-9083
Country	:	US
Telephone Number	:	330-875-5562
Fax Number	:	330-875-8947

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. ROBERT R CAMERON III
Credential	:	LNHA
Telephone Number	:	330-875-5562

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	03/25/2015

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Directions to “ST. JOSEPH CARE CENTER ” Practice Location

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