Basic Information
| Provider Information | |||||||||
| NPI: | 1801889621 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DEACONESS LONG TERM CARE OF OHIO, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CONTINENTAL MANOR NURSING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 615 ELSINORE PL STE 901 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452021459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134873600 | ||||||||
| FaxNumber: | 5134754325 | ||||||||
| Practice Location | |||||||||
| Address1: | 820 E CENTER ST | ||||||||
| Address2: | |||||||||
| City: | BLANCHESTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451071310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9377834949 | ||||||||
| FaxNumber: | 9377835820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2005 | ||||||||
| LastUpdateDate: | 01/27/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MURTA | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 5135592265 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 1766N | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 2045503 | 05 | OH | MEDICAID |