Healthcare Provider Details

I. General information

NPI: 1649467648
Provider Name (Legal Business Name): WINDSOR MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1454 E MAPLE ST
NORTH CANTON OH
44720-2634
US

IV. Provider business mailing address

1454 E MAPLE ST
NORTH CANTON OH
44720-2634
US

V. Phone/Fax

Practice location:
  • Phone: 330-499-8300
  • Fax: 330-966-8300
Mailing address:
  • Phone: 330-499-8300
  • Fax: 330-966-8300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number0166N
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS ROBERT SWALLEN
Title or Position: PRESIDENT
Credential: LNHA
Phone: 330-499-8300