Healthcare Provider Details

I. General information

NPI: 1255435673
Provider Name (Legal Business Name): STOW-GLEN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4285 KENT RD
STOW OH
44224-4355
US

IV. Provider business mailing address

4285 KENT RD
STOW OH
44224-4355
US

V. Phone/Fax

Practice location:
  • Phone: 330-686-7170
  • Fax:
Mailing address:
  • Phone: 330-686-7170
  • 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: TAMMY DENTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 330-686-7170