Provider Demographics
NPI:1750468237
Name:SPRINGFIELD HEALTH CARE OPERATING COMPANY, LLC
Entity Type:Organization
Organization Name:SPRINGFIELD HEALTH CARE OPERATING COMPANY, LLC
Other - Org Name:SPRINGFIELD MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:BARTLEBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-425-4696
Mailing Address - Street 1:2457 BROADWAY AVENUE
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44146
Mailing Address - Country:US
Mailing Address - Phone:440-439-7976
Mailing Address - Fax:440-232-7113
Practice Address - Street 1:404 E. MCCREIGHT AVE.
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503
Practice Address - Country:US
Practice Address - Phone:937-399-8311
Practice Address - Fax:937-399-7370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1044N313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0391204Medicaid
OH0391204Medicaid