Healthcare Provider Details

I. General information

NPI: 1386616829
Provider Name (Legal Business Name): ALTERCARE OF WADSWORTH CENTER FOR REHABILITATION & NURSING CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 GARFIELD ST
WADSWORTH OH
44281-1431
US

IV. Provider business mailing address

339 E MAPLE ST SUITE 100
NORTH CANTON OH
44720-2593
US

V. Phone/Fax

Practice location:
  • Phone: 330-335-2555
  • Fax:
Mailing address:
  • Phone: 330-498-8101
  • Fax: 330-498-8108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number6128
License Number StateOH

VIII. Authorized Official

Name: MS. KATHLEEN R JOHNSON
Title or Position: VP FINANCE/CONTROLLER
Credential:
Phone: 330-498-5233