Healthcare Provider Details

I. General information

NPI: 1205924685
Provider Name (Legal Business Name): HOLZER SENIOR CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 10/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 COLONIAL DR
BIDWELL OH
45614-9215
US

IV. Provider business mailing address

380 COLONIAL DR
BIDWELL OH
45614-9215
US

V. Phone/Fax

Practice location:
  • Phone: 740-446-5001
  • Fax: 740-446-5101
Mailing address:
  • Phone: 740-446-5001
  • Fax: 740-446-5101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberN/A IN OHIO
License Number State

VIII. Authorized Official

Name: WILLIAM CRABTREE
Title or Position: VICE PRESIDENT FINANCE
Credential:
Phone: 740-288-0192