Diversicare of Bradford Place, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

DIVERSICARE OF BRADFORD PLACE, LLC

Practice address

1302 Millville Ave
Hamilton, OH 45013-3961

Phone

(513) 867-4100

Fax

(513) 867-1415

NPI assigned

May 27, 2021

Organization subpart

No

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

Authorized official

Name

James R. McKnight Jr.

Title

Ceo

Phone

(615) 771-7575

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Diversicare of Bradford Place Doing business as

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

{
    "created_epoch": "1622073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622073600000",
    "number": "1902472236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1302 MILLVILLE AVE",
            "city": "HAMILTON",
            "state": "OH",
            "postal_code": "450133961",
            "telephone_number": "513-867-4100",
            "fax_number": "513-867-1415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1302 MILLVILLE AVE",
            "city": "HAMILTON",
            "state": "OH",
            "postal_code": "450133961",
            "telephone_number": "513-867-4100",
            "fax_number": "513-867-1415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSICARE OF BRADFORD PLACE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-27",
        "last_updated": "2021-05-27",
        "certification_date": "2021-05-18",
        "status": "A",
        "authorized_official_last_name": "MCKNIGHT",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "615-771-7575",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0096324",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Diversicare of Bradford Place",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• David Robert Dinuoscio, M.D.
• Isabella Melissa Disalvo, CDCA 1
• Browyn Dishun
• Melinda Ditmer
• Diversicare of Bradford Place, LLC
• Russell Dean Dixon
• Brandy R Doerr
• Margaret Dole
• Erika K Dollard, PA-C
• Corryn Domina

• Assisted Living Facility in Hamilton, OH
• Providers in Hamilton, OH by specialty
• Assisted Living Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2021; 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.