Healthcare Provider Details

I. General information

NPI: 1336232909
Provider Name (Legal Business Name): ST. LUKE LUTHERAN HOME FOR THE AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 APPLEGROVE ST. NE
NORTH CANTON OH
44720
US

IV. Provider business mailing address

220 APPLEGROVE ST NE
NORTH CANTON OH
44720-1610
US

V. Phone/Fax

Practice location:
  • Phone: 330-499-8341
  • Fax: 330-497-6141
Mailing address:
  • Phone: 330-499-8341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number001252H
License Number StateOH

VIII. Authorized Official

Name: JOYCE L MOHLER
Title or Position: CFO
Credential:
Phone: 330-499-8341