Basic Information
| Provider Information | |||||||||
| NPI: | 1629092275 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HCF OF CELINA, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CELINA MANOR | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 MYERS RD | ||||||||
| Address2: | |||||||||
| City: | CELINA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458221137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195866645 | ||||||||
| FaxNumber: | 4195865858 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 MYERS RD | ||||||||
| Address2: | |||||||||
| City: | CELINA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458221137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195866645 | ||||||||
| FaxNumber: | 4195865858 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 10/16/2012 | ||||||||
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| AuthorizedOfficialLastName: | STECHSCHULTE | ||||||||
| AuthorizedOfficialFirstName: | RYAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR - CORPORATE COMPLIANCE | ||||||||
| AuthorizedOfficialTelephone: | 4199992010 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 1666N | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 000000317807 | 01 | OH | ANTHEM | OTHER | 1003325 | 01 | OH | OHIO HEALTH CHOICE INC. | OTHER | 2437303 | 05 | OH | MEDICAID |