Healthcare Provider Details

I. General information

NPI: 1801855739
Provider Name (Legal Business Name): GOLDEN KEY CORP OF KENTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N WAYNE ST
KENTON OH
43326-1536
US

IV. Provider business mailing address

320 N WAYNE ST
KENTON OH
43326-1536
US

V. Phone/Fax

Practice location:
  • Phone: 419-673-1295
  • Fax: 419-673-9834
Mailing address:
  • Phone: 419-673-1295
  • Fax: 419-673-9834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1496N
License Number StateOH

VIII. Authorized Official

Name: MRS. SANDY K WILKINSON
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 419-673-1295