NPIMap

Organization Active NPI

Deaconess Long Term Care of Ohio, Inc.

Doing business as Convoy Care Center

  • Skilled Nursing Facility
  • Convoy, OH
National Provider Identifier
1043203722
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
1767N Issued in OH
Legal business name
DEACONESS LONG TERM CARE OF OHIO, INC.
Doing business as
Convoy Care Center
Practice address
127 Mentzer Dr
Convoy, OH 45832
Phone
(419) 749-2194
Fax
(419) 749-2424
NPI assigned
Aug 26, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Carla Brooks
Title
Cfo
Phone
(513) 487-3600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 1767N OH Primary

Addresses

Primary practice location

127 Mentzer Dr
Convoy, OH 45832

Mailing address

440 Lafayette Ave
Ste 400
Cincinnati, OH 45220-1022
Phone (513) 487-3600

Other identifiers 1

IdentifierTypeStateIssuer
0214771MedicaidOH

Other names 1

  • Convoy Care Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ava Place3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1125014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043203722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 LAFAYETTE AVE",
            "address_2": "STE 400",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452201022",
            "telephone_number": "513-487-3600",
            "fax_number": "513-487-3653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "127 MENTZER DR",
            "city": "CONVOY",
            "state": "OH",
            "postal_code": "45832",
            "telephone_number": "419-749-2194",
            "fax_number": "419-749-2424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEACONESS LONG TERM CARE OF OHIO, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "CARLA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "513-487-3600"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "1767N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0214771",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Convoy Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Convoy, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.