Healthcare Provider Details

I. General information

NPI: 1184722522
Provider Name (Legal Business Name): GILLETTE NURSING HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 ELM RD NE
WARREN OH
44483-2614
US

IV. Provider business mailing address

3310 ELM RD NE
WARREN OH
44483-2614
US

V. Phone/Fax

Practice location:
  • Phone: 330-372-1960
  • Fax: 330-372-6132
Mailing address:
  • Phone: 330-372-1960
  • Fax: 330-372-6132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number4321
License Number StateOH

VIII. Authorized Official

Name: MR. DOUGLAS A STEIN
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 330-372-1960