Healthcare Provider Details

I. General information

NPI: 1679091565
Provider Name (Legal Business Name): PIKETON NURSING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 08/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 OVERLOOK DR
PIKETON OH
45661-9760
US

IV. Provider business mailing address

1535 ROCKAWAY PKWY
BROOKLYN NY
11236-4001
US

V. Phone/Fax

Practice location:
  • Phone: 740-289-4074
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER SHERMAN
Title or Position: MANAGING MEMBER
Credential:
Phone: 718-688-8760