Healthcare Provider Details

I. General information

NPI: 1144968512
Provider Name (Legal Business Name): WARREN OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 05/25/2022
Certification Date: 05/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1926 RIDGE AVE SE
WARREN OH
44484-2821
US

IV. Provider business mailing address

132 E DELAWARE PL APT 6102
CHICAGO IL
60611-4954
US

V. Phone/Fax

Practice location:
  • Phone: 330-369-4672
  • Fax:
Mailing address:
  • Phone:
  • 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: BRAD J. GOLD
Title or Position: MANAGER
Credential:
Phone: 310-383-1792