MEDICARE: ASSISTED LIVING MINISTRY SERVICES

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	2570R	OH
2	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1649578881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSISTED LIVING MINISTRY SERVICES

Provider Business Mailing Address
First Line	:	650 SAINT CLAIR AVE
Second Line	:
City	:	EAST LIVERPOOL
State	:	OH
Zip	:	43920-3053
Country	:	US
Telephone Number	:	330-385-0700
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 SAINT CLAIR AVE
Second Line	:
City	:	EAST LIVERPOOL
State	:	OH
Zip	:	43920-3053
Country	:	US
Telephone Number	:	330-385-0700
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BRENDA HAUGHT
Credential	:
Telephone Number	:	330-206-0700

Provider Enumeration Date	:	03/12/2011
Last Update Date	:	03/12/2011

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