Provider Demographics
NPI:1043425291
Name:SPRING CREEK OF IHS, INC.
Entity Type:Organization
Organization Name:SPRING CREEK OF IHS, INC.
Other - Org Name:SPRING CREEK NURSING & REHAB CARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUAY
Authorized Official - Suffix:III
Authorized Official - Credentials:CPA
Authorized Official - Phone:305-892-1790
Mailing Address - Street 1:1680 MICHIGAN AVE
Mailing Address - Street 2:SUITE 736
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-2538
Mailing Address - Country:US
Mailing Address - Phone:305-892-1790
Mailing Address - Fax:305-538-2699
Practice Address - Street 1:5440 CHARLESGATE RD
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-1049
Practice Address - Country:US
Practice Address - Phone:305-892-1790
Practice Address - Fax:305-538-2699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1795N313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0560101Medicaid
365627Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER