Provider Demographics
NPI:1831130145
Name:TANDEM HEALTH CARE OF TALLMADGE, INC.
Entity Type:Organization
Organization Name:TANDEM HEALTH CARE OF TALLMADGE, INC.
Other - Org Name:SUMMIT VILLA CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-571-1550
Mailing Address - Street 1:800 CONCOURSE PKWY S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-6148
Mailing Address - Country:US
Mailing Address - Phone:407-571-1550
Mailing Address - Fax:407-571-1599
Practice Address - Street 1:330 SOUTHWEST AVE
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2235
Practice Address - Country:US
Practice Address - Phone:330-633-0555
Practice Address - Fax:330-633-5012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0731N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2150363Medicaid
5071100001Medicare NSC
366010Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER