Healthcare Provider Details

I. General information

NPI: 1164939583
Provider Name (Legal Business Name): ALTERCARE COSHOCTON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1991 OTSEGO AVE
COSHOCTON OH
43812-9370
US

IV. Provider business mailing address

PO BOX 550
GREEN OH
44232-0550
US

V. Phone/Fax

Practice location:
  • Phone: 740-622-2074
  • Fax: 740-622-5501
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 Number
License Number State

VIII. Authorized Official

Name: MRS. KATHLEEN R JOHNSON
Title or Position: VP FINANCE/CONTROLLER
Credential:
Phone: 330-498-5233