Provider Demographics
NPI:1104161595
Name:HCF OF BOWLING GREEN CARE CENTER, INC.
Entity type:Organization
Organization Name:HCF OF BOWLING GREEN CARE CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR - CORPORATE COMPLIANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STECHSCHULTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-999-2010
Mailing Address - Street 1:850 W POE RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-1219
Mailing Address - Country:US
Mailing Address - Phone:419-352-7558
Mailing Address - Fax:419-354-9501
Practice Address - Street 1:850 W POE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-1219
Practice Address - Country:US
Practice Address - Phone:419-352-7558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-11
Last Update Date:2020-04-29
Deactivation Date:2020-03-13
Deactivation Code:
Reactivation Date:2020-04-29
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0077230Medicaid
365076Medicare Oscar/Certification