Provider Demographics
NPI:1598749764
Name:CHS - MT. HEALTHY, INC
Entity Type:Organization
Organization Name:CHS - MT. HEALTHY, INC
Other - Org Name:THE HOME AT HEARTHSTONE
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 1:8028 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-2322
Practice Address - Country:US
Practice Address - Phone:513-521-2700
Practice Address - Fax:513-522-2894
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
OH2380-NH314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2364052Medicaid
OH2364052Medicaid