Provider Demographics
NPI:1215014238
Name:TRILOGY HEALTHCARE OPERATIONS OF SPRINGFIELD, LLC
Entity Type:Organization
Organization Name:TRILOGY HEALTHCARE OPERATIONS OF SPRINGFIELD, LLC
Other - Org Name:FOREST GLEN HEALTH CAMPUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF LEGAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-412-5847
Mailing Address - Street 1:2150 MONTEGO DRIVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-1304
Mailing Address - Country:US
Mailing Address - Phone:937-390-9913
Mailing Address - Fax:937-390-9915
Practice Address - Street 1:2150 MONTEGO DRIVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-1304
Practice Address - Country:US
Practice Address - Phone:937-390-9913
Practice Address - Fax:937-390-9915
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRILOGY OPCO, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-01
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X
OH0968N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0077107Medicaid
OH2822020Medicaid
OH2726170Medicaid
OH2726170Medicaid