1861478174 NPI number — CARROLL HEALTHCARE CENTER INC

Table of content: (NPI 1861478174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861478174 NPI number — CARROLL HEALTHCARE CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARROLL HEALTHCARE CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861478174
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
648 LONGHORN ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARROLLTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44615-9469
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-627-5501
Provider Business Mailing Address Fax Number:
330-627-3649

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
648 LONGHORN STREET NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARROLITON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44615-9471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-627-5501
Provider Business Practice Location Address Fax Number:
330-627-3649
Provider Enumeration Date:
12/19/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOWELL
Authorized Official First Name:
STACEY
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
NHA
Authorized Official Telephone Number:
330-965-9200

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  5021 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0430028 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".