Tandem Health Care of Lucasville II, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0685N Issued in OH

Legal business name

TANDEM HEALTH CARE OF LUCASVILLE II, INC.

Doing business as

Edgewood Manor of Lucasville II

Practice address

10098A Big Bear Creek Road
Lucasville, OH 45648-0789

Phone

(740) 259-2351

Fax

(740) 259-9061

NPI assigned

Jun 22, 2006

Organization subpart

No

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

Authorized official

Name

Joseph Conte

Title

Chief Operating Officer

Phone

(407) 571-1550

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Edgewood Manor of Lucasville II Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Herman L Colley III

  • Physical Therapy Assistant
  • Lucasville, OH
  • NPI 1184963589
  NPD (past)

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

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790721983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 CONCOURSE PKWY S",
            "address_2": "SUITE 200",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327516148",
            "telephone_number": "407-571-1550",
            "fax_number": "407-571-1599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10098A BIG BEAR CREEK ROAD",
            "city": "LUCASVILLE",
            "state": "OH",
            "postal_code": "456480789",
            "telephone_number": "740-259-2351",
            "fax_number": "740-259-9061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TANDEM HEALTH CARE OF LUCASVILLE II, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CONTE",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "407-571-1550"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "0685N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2148769",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edgewood Manor of Lucasville II",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dannette Swain, RN, ADN
• Donna Marie Tackett
• Katrina Tackett
• Kimberly Tackett
• Tandem Health Care of Lucasville I, Inc. (Edgewood of Lucasville I)
• Trinity Faith Thomas
• Vickie S Toller
• Kristal Trent
• Susan Berniece Tully
• Terry Leora Tuttle, LPN

• Skilled Nursing Facility in Lucasville, OH
• Providers in Lucasville, 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.