Healthcare Provider Details

I. General information

NPI: 1578664272
Provider Name (Legal Business Name): NEWCOMERSTOWN PROGRESS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E STATE RD
NEWCOMERSTOWN OH
43832-9446
US

IV. Provider business mailing address

1100 E STATE RD
NEWCOMERSTOWN OH
43832-9446
US

V. Phone/Fax

Practice location:
  • Phone: 740-498-5165
  • Fax: 740-498-6127
Mailing address:
  • Phone: 740-498-5165
  • Fax: 740-498-6127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1665
License Number StateOH

VIII. Authorized Official

Name: MR. DWAYNE N SHEPHERD
Title or Position: ADMINISTRATOR
Credential:
Phone: 740-498-5165