1770581878 NPI number — EASTGATE HEALTH CARE CENTER, LLC

Table of content: (NPI 1770581878)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770581878 NPI number — EASTGATE HEALTH CARE CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTGATE HEALTH CARE CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770581878
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
390 WARDS CORNER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45140-6969
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-943-4000
Provider Business Mailing Address Fax Number:
513-943-4240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4400 GLEN ESTE WITHAMSVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45245-1306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-752-3710
Provider Business Practice Location Address Fax Number:
513-752-7603
Provider Enumeration Date:
07/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
EPPERS
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
513-707-1537

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  1848 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0770956 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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