Provider Demographics
NPI:1689660631
Name:DUAL CC, INC.
Entity Type:Organization
Organization Name:DUAL CC, INC.
Other - Org Name:DUAL MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-751-4900
Mailing Address - Street 1:515 MARTIN LUTHER KING DR E
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3316
Mailing Address - Country:US
Mailing Address - Phone:513-961-2853
Mailing Address - Fax:513-487-6885
Practice Address - Street 1:515 MARTIN LUTHER KING DR E
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3316
Practice Address - Country:US
Practice Address - Phone:513-961-2853
Practice Address - Fax:513-487-6885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH520009314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2472640Medicaid
OH5491620001OtherDME
OH2472640Medicaid
OH365942Medicare ID - Type Unspecified