Provider Demographics
NPI:1952300113
Name:ST. JOSEPH CARE CENTER
Entity Type:Organization
Organization Name:ST. JOSEPH CARE CENTER
Other - Org Name:ST. JOSEPH HOSPICE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:III
Authorized Official - Credentials:LNHA
Authorized Official - Phone:330-875-5562
Mailing Address - Street 1:2308 RENO DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-9083
Mailing Address - Country:US
Mailing Address - Phone:330-875-5562
Mailing Address - Fax:330-875-8947
Practice Address - Street 1:2308 RENO DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:44641-9083
Practice Address - Country:US
Practice Address - Phone:330-875-5562
Practice Address - Fax:330-875-8947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4986310400000X
OH5432313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0298735Medicaid
OH365904Medicare ID - Type UnspecifiedMEDICARE NUMBER
OH0298735Medicaid