Tandem Healthcare of Wellston, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1225N Issued in OH

Legal business name

TANDEM HEALTHCARE OF WELLSTON, INC.

Doing business as

Edgewood Manor Of Wellston

Practice address

405 N Park Ave
Wellston, OH 45692-1111

Phone

(740) 384-5611

Fax

(740) 384-2707

NPI assigned

Jun 11, 2006

Last updated

Aug 22, 2020By the provider in NPPES

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 Wellston Doing business as

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1942242409",
    "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": "405 N PARK AVE",
            "city": "WELLSTON",
            "state": "OH",
            "postal_code": "456921111",
            "telephone_number": "740-384-5611",
            "fax_number": "740-384-2707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TANDEM HEALTHCARE OF WELLSTON, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "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": "1225N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2148778",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edgewood Manor Of Wellston",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ryan Souders
• Beth Ann Spurlock
• Erica Squires
• Brandy L Stacey
• Mary Stevens, CPHT
• Shylynn Briann Taylor
• Tracey Taylor, RDH
• Kaylee Taynor
• Stephen Thaxton
• April Lynn Thomas

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