Provider Demographics
NPI:1073020236
Name:SPRING MEADOW HEALTHCARE LLC
Entity Type:Organization
Organization Name:SPRING MEADOW HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-825-6622
Mailing Address - Street 1:544 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-9704
Mailing Address - Country:US
Mailing Address - Phone:937-825-6622
Mailing Address - Fax:
Practice Address - Street 1:1649 PARK RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:OH
Practice Address - Zip Code:43084-9713
Practice Address - Country:US
Practice Address - Phone:937-825-6622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility