Provider Demographics
NPI:1114107596
Name:CARRIAGE INN OF TROTWOOD, INC
Entity Type:Organization
Organization Name:CARRIAGE INN OF TROTWOOD, INC
Other - Org Name:SHILOH SPRINGS CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-277-0505
Mailing Address - Street 1:5020 PHILADELPHIA DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-3653
Mailing Address - Country:US
Mailing Address - Phone:937-277-0505
Mailing Address - Fax:
Practice Address - Street 1:3500 SHILOH SPRINGS RD
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-2260
Practice Address - Country:US
Practice Address - Phone:937-854-1180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1970N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2773146Medicaid
OH366302Medicare Oscar/Certification