MEDICARE: PIGEON RUN, LLC

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1942533260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIGEON RUN, LLC

Provider Business Mailing Address
First Line	:	3750 PIGEON RUN RD SW
Second Line	:
City	:	MASSILLON
State	:	OH
Zip	:	44647-9756
Country	:	US
Telephone Number	:	330-704-1770
Fax Number	:	330-762-1862

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	:	330-762-1862

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. KIM COLERIDGE
Credential	:
Telephone Number	:	330-704-1770

Provider Enumeration Date	:	09/18/2009
Last Update Date	:	09/18/2009

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Directions to “PIGEON RUN, LLC ” Practice Location

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