Healthcare Provider Details

I. General information

NPI: 1467600726
Provider Name (Legal Business Name): LAGRANGE NURSING & REHABILITATION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 05/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 OPPORTUNITY WAY
LAGRANGE OH
44050-9019
US

IV. Provider business mailing address

6967 DEER TRAIL AVE NE
CANTON OH
44721-2069
US

V. Phone/Fax

Practice location:
  • Phone: 440-355-4616
  • Fax: 440-355-4616
Mailing address:
  • Phone: 330-936-7158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2521N
License Number StateOH

VIII. Authorized Official

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