Healthcare Provider Details

I. General information

NPI: 1770770984
Provider Name (Legal Business Name): WEST LAFAYETTE HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 E MAIN ST
WEST LAFAYETTE OH
43845-1267
US

IV. Provider business mailing address

6967 DEER TRAIL AVE NE
CANTON OH
44721-2069
US

V. Phone/Fax

Practice location:
  • Phone: 740-545-6355
  • Fax: 740-545-6763
Mailing address:
  • Phone: 330-936-7158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1530
License Number StateOH

VIII. Authorized Official

Name: JOE ALTIERI
Title or Position: PRESIDENT
Credential:
Phone: 330-936-7158