Provider Demographics
NPI:1528042736
Name:CHS - CLERMONT NCC, INC.
Entity Type:Organization
Organization Name:CHS - CLERMONT NCC, INC.
Other - Org Name:CLERMONT NURSING CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-204-1040
Mailing Address - Street 1:782 W ORANGE RD
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-8922
Mailing Address - Country:US
Mailing Address - Phone:330-204-1040
Mailing Address - Fax:
Practice Address - Street 1:934 STATE ROUTE 28
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-1912
Practice Address - Country:US
Practice Address - Phone:513-831-1770
Practice Address - Fax:513-831-5184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1307N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2515568Medicaid
OH2515568Medicaid