Provider Demographics
NPI:1346219987
Name:SHAWNEESPRING HEALTH CARE CENTER, LLC
Entity Type:Organization
Organization Name:SHAWNEESPRING HEALTH CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:N
Authorized Official - Last Name:BORTZ
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:513-943-4000
Mailing Address - Street 1:390 WARDS CORNER RD
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-6969
Mailing Address - Country:US
Mailing Address - Phone:513-943-4000
Mailing Address - Fax:513-943-4240
Practice Address - Street 1:10111 SIMONSON RD
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:OH
Practice Address - Zip Code:45030-2003
Practice Address - Country:US
Practice Address - Phone:513-367-7780
Practice Address - Fax:513-367-7781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2438N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2618635Medicaid
OH366320Medicare ID - Type Unspecified