Healthcare Provider Details

I. General information

NPI: 1427319102
Provider Name (Legal Business Name): IMPERIAL OPERATING CO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 TOD AVE NW
WARREN OH
44485-1258
US

IV. Provider business mailing address

4121 TOD AVE NW
WARREN OH
44485-1258
US

V. Phone/Fax

Practice location:
  • Phone: 330-898-4373
  • Fax: 330-898-1407
Mailing address:
  • Phone: 330-898-4373
  • Fax: 330-898-1407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1254
License Number StateOH

VIII. Authorized Official

Name: MR. JOSEPH CILONE JR.
Title or Position: PRESIDENT
Credential:
Phone: 330-898-4373