Provider Demographics
NPI:1598945230
Name:COMPREHENSIVE GERIATRIC CARE, LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE GERIATRIC CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:BERNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-901-2876
Mailing Address - Street 1:1110 OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45419-2911
Mailing Address - Country:US
Mailing Address - Phone:419-206-1249
Mailing Address - Fax:419-868-1503
Practice Address - Street 1:1110 OAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:OH
Practice Address - Zip Code:45419-2911
Practice Address - Country:US
Practice Address - Phone:419-206-1249
Practice Address - Fax:419-868-1503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207QG0300X
OH35082789310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2428859Medicaid
OHBE4169712Medicare PIN
OH2428859Medicaid