Healthcare Provider Details

I. General information

NPI: 1659888071
Provider Name (Legal Business Name): ALTERCARE NEWARK SOUTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 FORRY ST
NEWARK OH
43055-4004
US

IV. Provider business mailing address

PO BOX 550
GREEN OH
44232-0550
US

V. Phone/Fax

Practice location:
  • Phone: 740-345-9197
  • Fax: 855-795-1429
Mailing address:
  • Phone: 330-498-8101
  • Fax: 330-498-8108

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: MRS. KATHLEEN R JOHNSON
Title or Position: VP FINANCE/CONTROLLER
Credential:
Phone: 330-498-5233