Healthcare Provider Details

I. General information

NPI: 1851509665
Provider Name (Legal Business Name): ANTONINE SISTERS ADULT DAY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 N LIPKEY RD
NORTH JACKSON OH
44451-9665
US

IV. Provider business mailing address

2675 N LIPKEY RD
NORTH JACKSON OH
44451-9665
US

V. Phone/Fax

Practice location:
  • Phone: 330-538-9822
  • Fax: 330-538-9820
Mailing address:
  • Phone: 330-538-9822
  • Fax: 330-538-9820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIE MADELEINE ISKANDAR
Title or Position: DIRECTOR
Credential:
Phone: 330-538-9822