NPIMap

Organization Active NPI

Tandem Health Care of Lucasville I, Inc.

Doing business as Edgewood of Lucasville I

  • Skilled Nursing Facility
  • Lucasville, OH
National Provider Identifier
1972530392
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
1761N Issued in OH
Legal business name
TANDEM HEALTH CARE OF LUCASVILLE I, INC.
Doing business as
Edgewood of Lucasville I
Practice address
10098 Big Bear Creek Road
Lucasville, OH 45648-0789
Phone
(740) 259-5536
Fax
(740) 259-2531
NPI assigned
Jun 28, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 1761N OH Primary

Addresses

Primary practice location

10098 Big Bear Creek Road
Lucasville, OH 45648-0789

Mailing address

800 Concourse Pkwy S
Suite 200
Maitland, FL 32751-6148
Phone (407) 571-1550

Other identifiers 1

IdentifierTypeStateIssuer
2148750MedicaidOH

Other names 1

  • Edgewood of Lucasville I Doing business as

National Provider Directory

National Provider Directory

Locations

10098 Bear Creek Rd
Lucasville, OH 45648
Phone (740) 259-5536

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1972530392",
    "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": "10098 BIG BEAR CREEK ROAD",
            "city": "LUCASVILLE",
            "state": "OH",
            "postal_code": "456480789",
            "telephone_number": "740-259-5536",
            "fax_number": "740-259-2531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TANDEM HEALTH CARE OF LUCASVILLE I, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-28",
        "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": "1761N",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2148750",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edgewood of Lucasville I",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lucasville, OH

Sources for this page

  • 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.