Covenant Care Ohio, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

5494 Issued in OH

Legal business name

COVENANT CARE OHIO, INC

Doing business as

Villa Georgetown

Practice address

8065 Dr Faul Rd
Georgetown, OH 45121-8811

Phone

(937) 378-4178

Fax

(937) 378-3107

NPI assigned

Oct 7, 2005

Organization subpart

No

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

Authorized official

Name

Carol A Sparks

Title

Director OT Reimbursement

Phone

(949) 349-1200

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Villa Georgetown Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Covenant Care California, LLC

  • Skilled Nursing Facility
  • Long Beach, CA
  • NPI 1053453902

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1128643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225152000000",
    "number": "1184612707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8065 DR FAUL RD",
            "city": "GEORGETOWN",
            "state": "OH",
            "postal_code": "451218811",
            "telephone_number": "937-378-4178",
            "fax_number": "937-378-3107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8065 DR FAUL RD",
            "city": "GEORGETOWN",
            "state": "OH",
            "postal_code": "451218811",
            "telephone_number": "937-378-4178",
            "fax_number": "937-378-3107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT CARE OHIO, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-07",
        "last_updated": "2008-10-28",
        "status": "A",
        "authorized_official_last_name": "SPARKS",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR OT REIMBURSEMENT",
        "authorized_official_telephone_number": "949-349-1200"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "5494",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2056340",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Villa Georgetown",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Chelisa Kay Clifton
• Katlin Nicole Colwell
• Jordan D Connor
• Dora Jean Cooksey, LSW
• Gwen S Courts, MA MED EDD
• Emily Rae Craycraft
• Jill Cropper
• Stephanie J Cummings, CNP
• Daniel T Harning DDS Inc
• Tanika Davis, CDCA

• Skilled Nursing Facility in Georgetown, OH
• Providers in Georgetown, OH by specialty
• Skilled Nursing Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2008; 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.