Healthcare Provider Details

I. General information

NPI: 1255433413
Provider Name (Legal Business Name): HOOBERRY & ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 09/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 MILTON BLVD
NEWTON FALLS OH
44444-8746
US

IV. Provider business mailing address

2200 MILTON BLVD
NEWTON FALLS OH
44444-8746
US

V. Phone/Fax

Practice location:
  • Phone: 330-872-1990
  • Fax:
Mailing address:
  • Phone: 330-872-1990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3717
License Number StateOH

VIII. Authorized Official

Name: MRS. KATHY KOLESAR
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 330-872-1990