Basic Information
| Provider Information | |||||||||
| NPI: | 1750691432 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BROADVIEW NH, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE REHABILITATION AND HEALTH CENTER OF GAHANNA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5151 N HAMILTON RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432301313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143371066 | ||||||||
| FaxNumber: | 6143374039 | ||||||||
| Practice Location | |||||||||
| Address1: | 5151 N HAMILTON RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432301313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6143371066 | ||||||||
| FaxNumber: | 6143374039 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2010 | ||||||||
| LastUpdateDate: | 09/30/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MANDO | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8136359500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 3096153 | 05 | OH | MEDICAID |