MEDICARE: HOLANDER HOUSE, LTD

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	1140-N	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4643040001	OTHER	OH	DMERC REGION B CARRIER #

General Provider Information

NPI Number	:	1578566782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLANDER HOUSE, LTD

Provider Business Mailing Address
First Line	:	1985 EAST PERSHING STREET
Second Line	:
City	:	SALEM
State	:	OH
Zip	:	44460-0000
Country	:	US
Telephone Number	:	330-332-1588
Fax Number	:	330-332-3119

Provider Business Practice Location Address
First Line	:	1985 EAST PERSHING STREET
Second Line	:
City	:	SALEM
State	:	OH
Zip	:	44460-0000
Country	:	US
Telephone Number	:	330-332-1588
Fax Number	:	330-332-3119

Authorized Official
Title or Position	:	CEO/SALEM HEALTHCARE MANAGEMENT
Name	:	ALAN SCHWARTZ
Credential	:
Telephone Number	:	330-332-1588

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	11/20/2009

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Directions to “HOLANDER HOUSE, LTD ” Practice Location

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