Healthcare Provider Details

I. General information

NPI: 1750365920
Provider Name (Legal Business Name): CHS - HEATH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 S 30TH ST
HEATH OH
43056-1244
US

IV. Provider business mailing address

6967 DEER TRAIL AVE NE
CANTON OH
44721-2069
US

V. Phone/Fax

Practice location:
  • Phone: 740-522-1171
  • Fax: 740-522-8786
Mailing address:
  • Phone: 330-936-7158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1689N
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2515531
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name: JOE ALTIERI
Title or Position: PRESIDENT
Credential:
Phone: 330-936-7158