Healthcare Provider Details

I. General information

NPI: 1689662835
Provider Name (Legal Business Name): TWIN PINES RETREAT CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8720 E MARKET ST SUITE 1-B
WARREN OH
44484-2364
US

IV. Provider business mailing address

8720 E MARKET ST SUITE 1-B
WARREN OH
44484-2364
US

V. Phone/Fax

Practice location:
  • Phone: 330-856-6000
  • Fax: 330-856-6150
Mailing address:
  • Phone: 330-856-6000
  • Fax: 330-856-6150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number6126
License Number StateOH

VIII. Authorized Official

Name: MR. W SCOT PHILLIPS
Title or Position: FINANCIAL OPERATIONS OFFICER
Credential:
Phone: 330-856-6000