Healthcare Provider Details

I. General information

NPI: 1861478174
Provider Name (Legal Business Name): CARROLL HEALTHCARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

648 LONGHORN STREET NW
CARROLITON OH
44615-9471
US

IV. Provider business mailing address

648 LONGHORN ST NW
CARROLLTON OH
44615-9469
US

V. Phone/Fax

Practice location:
  • Phone: 330-627-5501
  • Fax: 330-627-3649
Mailing address:
  • Phone: 330-627-5501
  • Fax: 330-627-3649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number5021
License Number StateOH

VIII. Authorized Official

Name: MR. STACEY ALLEN HOWELL
Title or Position: NHA
Credential:
Phone: 330-965-9200