Provider Demographics
NPI:1912995176
Name:EDGERTON LONG TERM CARE, INC.
Entity Type:Organization
Organization Name:EDGERTON LONG TERM CARE, INC.
Other - Org Name:PARK VIEW NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
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 1:328 W VINE ST
Practice Address - Street 2:
Practice Address - City:EDGERTON
Practice Address - State:OH
Practice Address - Zip Code:43517-9600
Practice Address - Country:US
Practice Address - Phone:419-298-2321
Practice Address - Fax:419-298-2476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3591314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0124627Medicaid
OH0124627Medicaid
OH365570Medicare Oscar/Certification