Healthcare Provider Details

I. General information

NPI: 1568635662
Provider Name (Legal Business Name): PORTAGE TRAIL CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E BATH RD
CUYAHOGA FALLS OH
44223-2510
US

IV. Provider business mailing address

2335 N BANK DR
COLUMBUS OH
43220-5423
US

V. Phone/Fax

Practice location:
  • Phone: 330-929-6272
  • Fax: 330-922-4059
Mailing address:
  • Phone: 614-451-2151
  • Fax: 614-451-0351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JUDITH NADERHOFF
Title or Position: VICE PRESIDENT
Credential:
Phone: 614-451-2151