Provider Demographics
NPI:1295719763
Name:MONTGOMERY LONG TERM CARE, LLC
Entity type:Organization
Organization Name:MONTGOMERY LONG TERM CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHARFENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:513-793-8804
Mailing Address - Street 1:7265 KENWOOD RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-4400
Mailing Address - Country:US
Mailing Address - Phone:513-793-8804
Mailing Address - Fax:513-793-8799
Practice Address - Street 1:7777 COOPER RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-7703
Practice Address - Country:US
Practice Address - Phone:513-793-5092
Practice Address - Fax:513-984-2930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5676314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2111226Medicaid
OH365327Medicare Oscar/Certification
OH5326190001Medicare NSC