Provider Demographics
NPI:1376530063
Name:BOYKO MANAGEMENT, INC.
Entity Type:Organization
Organization Name:BOYKO MANAGEMENT, INC.
Other - Org Name:THE LODGE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRIEDMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-677-4900
Mailing Address - Street 1:9370 UNION CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-9577
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9370 UNION CEMETERY RD
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-9577
Practice Address - Country:US
Practice Address - Phone:513-677-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1975314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2149571Medicaid
OH365889Medicare ID - Type Unspecified