Healthcare Provider Details

I. General information

NPI: 1609848217
Provider Name (Legal Business Name): ALTERCARE OF BUCYRUS CENTER FOR REHABILITATION & NURSING CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1929 WHETSTONE ST
BUCYRUS OH
44820-3564
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 419-562-7644
  • Fax:
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 Number6065
License Number StateOH

VIII. Authorized Official

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