Healthcare Provider Details

I. General information

NPI: 1790787968
Provider Name (Legal Business Name): CANTERBURY VILLA OPERATIONS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 03/19/2024
Certification Date: 03/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1785 N FRESHLEY AVE
ALLIANCE OH
44601-8772
US

IV. Provider business mailing address

25000 COUNTRY CLUB BLVD STE 255
NORTH OLMSTED OH
44070-5337
US

V. Phone/Fax

Practice location:
  • Phone: 330-821-4000
  • Fax: 330-821-6127
Mailing address:
  • Phone: 440-793-2245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1774N
License Number StateOH

VIII. Authorized Official

Name: BRIAN COLLERAN
Title or Position: PRESIDENT
Credential:
Phone: 440-793-2245