Healthcare Provider Details

I. General information

NPI: 1346654829
Provider Name (Legal Business Name): STOW-GLEN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 GRAHAM RD
STOW OH
44224-3620
US

IV. Provider business mailing address

2950 GRAHAM RD
STOW OH
44224-3620
US

V. Phone/Fax

Practice location:
  • Phone: 330-686-7100
  • Fax: 330-686-7173
Mailing address:
  • Phone: 330-686-7100
  • Fax: 330-686-7173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateOH

VIII. Authorized Official

Name: TAMMY L DENTON
Title or Position: CEO
Credential: LNHA
Phone: 330-686-7100