204 W. Main Street Operating Company, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

204 W. MAIN STREET OPERATING COMPANY, LLC

Doing business as

New London Health Care Center

Practice address

204 W Main St
New London, OH 44851-1070

Phone

(419) 929-1563

NPI assigned

Aug 31, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Kevin P Breslin

Title

Executive Vice President - Cfo

Phone

(201) 242-4000

Specialties & licenses 1

Addresses

Other names 1

• New London Health Care Center Doing business as

Locations

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1457463556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 W MAIN ST",
            "city": "NEW LONDON",
            "state": "OH",
            "postal_code": "448511070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 W MAIN ST",
            "city": "NEW LONDON",
            "state": "OH",
            "postal_code": "448511070",
            "telephone_number": "419-929-1563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "204 W. MAIN STREET OPERATING COMPANY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BRESLIN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT - CFO",
        "authorized_official_telephone_number": "201-242-4000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New London Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Pooja Adhikari
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• Kate A. Bradley, RN, BSN
• Miranda Buza

• Skilled Nursing Facility in New London, OH
• Providers in New London, 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 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.