Healthcare Provider Details

I. General information

NPI: 1194812362
Provider Name (Legal Business Name): ASSUMPTION VILLAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 MARKET ST
NORTH LIMA OH
44452
US

IV. Provider business mailing address

9800 MARKET ST
NORTH LIMA OH
44452
US

V. Phone/Fax

Practice location:
  • Phone: 330-549-0740
  • Fax: 330-549-0701
Mailing address:
  • Phone: 330-549-0740
  • Fax: 330-549-0701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5085
License Number StateOH

VIII. Authorized Official

Name: MS. MARY LOU CLATTERBUCK
Title or Position: DIRECTOR
Credential:
Phone: 330-549-0740