Provider Demographics
NPI:1265167233
Name:BUCKEYE SENIOR REHAB LLC
Entity type:Organization
Organization Name:BUCKEYE SENIOR REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDWICK
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:937-902-8062
Mailing Address - Street 1:7750 PARAGON RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4050
Mailing Address - Country:US
Mailing Address - Phone:937-291-3780
Mailing Address - Fax:
Practice Address - Street 1:7750 PARAGON RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45459-4050
Practice Address - Country:US
Practice Address - Phone:937-291-3780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty