Healthcare Provider Details

I. General information

NPI: 1124783022
Provider Name (Legal Business Name): BUCKEYE FOREST AT CANTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 HIGBEE AVE NW
CANTON OH
44718-2521
US

IV. Provider business mailing address

50 CHESTNUT RIDGE RD STE 107
MONTVALE NJ
07645-1823
US

V. Phone/Fax

Practice location:
  • Phone: 330-492-7835
  • Fax:
Mailing address:
  • Phone: 908-327-6982
  • Fax:

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: LARRY KATZ
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 908-327-6982