Provider Demographics
NPI:1437533635
Name:CC SNF LLC
Entity Type:Organization
Organization Name:CC SNF LLC
Other - Org Name:COVINGTON CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WERTHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-919-7204
Mailing Address - Street 1:75 MOTE DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45318-1245
Mailing Address - Country:US
Mailing Address - Phone:937-473-2075
Mailing Address - Fax:937-473-2963
Practice Address - Street 1:75 MOTE DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:OH
Practice Address - Zip Code:45318-1245
Practice Address - Country:US
Practice Address - Phone:937-473-2075
Practice Address - Fax:937-473-2963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
365483Medicare Oscar/Certification