MEDICARE: WEST LAFAYETTE 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	1530	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	:	1770770984
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST LAFAYETTE HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	6967 DEER TRAIL AVE NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44721-2069
Country	:	US
Telephone Number	:	330-936-7158
Fax Number	:

Provider Business Practice Location Address
First Line	:	620 E MAIN ST
Second Line	:
City	:	WEST LAFAYETTE
State	:	OH
Zip	:	43845-1267
Country	:	US
Telephone Number	:	740-545-6355
Fax Number	:	740-545-6763

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOE ALTIERI
Credential	:
Telephone Number	:	330-936-7158

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	06/16/2014

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