Healthcare Provider Details

I. General information

NPI: 1326865601
Provider Name (Legal Business Name): FHS BENNINGTON, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 STATE ROUTE 61
MARENGO OH
43334-9215
US

IV. Provider business mailing address

825 STATE ROUTE 61
MARENGO OH
43334-9215
US

V. Phone/Fax

Practice location:
  • Phone: 440-793-2245
  • Fax: 440-614-0168
Mailing address:
  • Phone: 440-793-2245
  • Fax: 440-614-0168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SANDY MUIR
Title or Position: VP OF GOVERNMENT AFFAIRS
Credential:
Phone: 440-793-2245