Basic Information
| Provider Information | |||||||||
| NPI: | 1245643857 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLIFTON CARE CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 ASHWOOD DRIVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134897100 | ||||||||
| FaxNumber: | 5134897199 | ||||||||
| Practice Location | |||||||||
| Address1: | 625 PROBASCO ST | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452202710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132812464 | ||||||||
| FaxNumber: | 5132812559 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2014 | ||||||||
| LastUpdateDate: | 06/11/2014 | ||||||||
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| AuthorizedOfficialLastName: | HUMBERT | ||||||||
| AuthorizedOfficialFirstName: | MONICA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONTRACT | ||||||||
| AuthorizedOfficialTelephone: | 5135301622 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 1567N | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 0234428 | 05 | OH | MEDICAID |