Healthcare Provider Details

I. General information

NPI: 1255447843
Provider Name (Legal Business Name): BELMONT NURSING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 03/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28546 STARBRIGHT BLVD
PERRYSBURG OH
43551-4686
US

IV. Provider business mailing address

101 SUN AVE NE COMPLIANCE DEPARTMENT
ALBUQUERQUE NM
87109-4373
US

V. Phone/Fax

Practice location:
  • Phone: 419-666-0935
  • Fax: 419-666-5610
Mailing address:
  • Phone: 505-468-5604
  • Fax: 505-468-4681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number4273
License Number StateOH

VIII. Authorized Official

Name: THOMAS DIVITTORIO
Title or Position: PRESIDENT DIRECTOR
Credential:
Phone: 505-468-4742