Healthcare Provider Details

I. General information

NPI: 1629264379
Provider Name (Legal Business Name): PEREGRINE SERVICES OF CANTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 34TH ST NW
CANTON OH
44709-2947
US

IV. Provider business mailing address

1661 OLD HENDERSON RD
COLUMBUS OH
43220-3644
US

V. Phone/Fax

Practice location:
  • Phone: 614-459-2482
  • Fax: 614-459-2641
Mailing address:
  • Phone: 614-459-2656
  • Fax: 614-459-2641

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: MR. PAUL M DAUERMAN
Title or Position: CEO
Credential:
Phone: 614-459-2656