MEDICARE: HICKORY HEALTH CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	0525N	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508860495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HICKORY HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	25000 COUNTRY CLUB BLVD STE 255
Second Line	:
City	:	NORTH OLMSTED
State	:	OH
Zip	:	44070-5337
Country	:	US
Telephone Number	:	440-614-0160
Fax Number	:

Provider Business Practice Location Address
First Line	:	721 HICKORY ST
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44303-2213
Country	:	US
Telephone Number	:	330-762-6486
Fax Number	:	330-762-1230

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANIEL PARKER
Credential	:
Telephone Number	:	330-554-6619

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	11/05/2020

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