Healthcare Provider Details

I. General information

NPI: 1063433225
Provider Name (Legal Business Name): COMMUNITY SKILLED NURSING CENTRE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 08/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 MAHONING AVE NW
WARREN OH
44483-2002
US

IV. Provider business mailing address

1320 MAHONING AVE NW
WARREN OH
44483-2002
US

V. Phone/Fax

Practice location:
  • Phone: 330-373-1160
  • Fax: 330-392-3649
Mailing address:
  • Phone: 330-373-1160
  • Fax: 330-392-3649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2864
License Number StateOH

VIII. Authorized Official

Name: MR. RAYMOND DECRISTOFARO
Title or Position: CFO
Credential: CPA
Phone: 330-373-1160