Healthcare Provider Details

I. General information

NPI: 1811488612
Provider Name (Legal Business Name): SIDNEY SNF, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 FULTON ST
SIDNEY OH
45365-3203
US

IV. Provider business mailing address

705 FULTON ST
SIDNEY OH
45365-3203
US

V. Phone/Fax

Practice location:
  • Phone: 937-492-9591
  • Fax:
Mailing address:
  • Phone: 330-856-4232
  • 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: DAN DAMICO
Title or Position: COO
Credential:
Phone: 330-856-4232