Healthcare Provider Details

I. General information

NPI: 1417464801
Provider Name (Legal Business Name): ALTERCARE ADENA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2018
Last Update Date: 01/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 U S ROUTE 250
ADENA OH
43901-7925
US

IV. Provider business mailing address

339 E MAPLE ST STE 100
NORTH CANTON OH
44720-2593
US

V. Phone/Fax

Practice location:
  • Phone: 740-546-3620
  • Fax: 740-546-4120
Mailing address:
  • Phone: 330-498-8101
  • Fax: 330-498-8108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. KATHLEEN R JOHNSON
Title or Position: VP FINANCE/CONTROLLER
Credential:
Phone: 330-498-5233