Healthcare Provider Details

I. General information

NPI: 1457359432
Provider Name (Legal Business Name): BOYD'S KINSMAN HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7929 STATE ROUTE #5
KINSMAN OH
44428-0315
US

IV. Provider business mailing address

PO BOX 315 7929 STATE ROUTE #5
KINSMAN OH
44428-0315
US

V. Phone/Fax

Practice location:
  • Phone: 330-876-5581
  • Fax:
Mailing address:
  • Phone:
  • Fax: 330-876-8804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number7810042
License Number StateOH

VIII. Authorized Official

Name: MRS. PAULA L. RUBY
Title or Position: NURSING HOME ADMINISTRATOR
Credential: LNHA, QMRP
Phone: 330-876-5581