Provider Demographics
NPI:1164933701
Name:COTTINGHAM RETIREMENT COMMUNITY, INC.
Entity Type:Organization
Organization Name:COTTINGHAM RETIREMENT COMMUNITY, INC.
Other - Org Name:COTTINGHAM RETIREMENT COMMUNITY-ASST LIVING
Other - Org Type:Other Name
Authorized Official - Title/Position:CONTROLLER/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRASER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-487-3635
Mailing Address - Street 1:3995 COTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-1680
Mailing Address - Country:US
Mailing Address - Phone:513-563-3600
Mailing Address - Fax:513-563-3717
Practice Address - Street 1:3995 COTTINGHAM DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-1680
Practice Address - Country:US
Practice Address - Phone:513-563-3600
Practice Address - Fax:513-563-3717
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COTTINGHAM RETIREMENT COMMUNITY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1792R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2316158Medicaid