Healthcare Provider Details

I. General information

NPI: 1083711352
Provider Name (Legal Business Name): MAIN STREET TERRACE CARE CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1318 E MAIN ST
LANCASTER OH
43130-4004
US

IV. Provider business mailing address

1318 E MAIN ST
LANCASTER OH
43130-4004
US

V. Phone/Fax

Practice location:
  • Phone: 740-653-8767
  • Fax: 740-653-8919
Mailing address:
  • Phone: 740-653-8767
  • Fax: 740-653-8919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number4912
License Number StateOH

VIII. Authorized Official

Name: MRS. CHAIM HERTANU
Title or Position: OWNER
Credential:
Phone: 845-205-6813