Healthcare Provider Details

I. General information

NPI: 1295037463
Provider Name (Legal Business Name): BOARDMAN SKILLED NURSING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2010
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 BOARDMAN CANFIELD RD
YOUNGSTOWN OH
44512-4213
US

IV. Provider business mailing address

2875 CENTER RD STE 6
BRUNSWICK OH
44212-2319
US

V. Phone/Fax

Practice location:
  • Phone: 330-758-8106
  • Fax: 330-758-7030
Mailing address:
  • Phone: 216-772-1105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1510N
License Number StateOH

VIII. Authorized Official

Name: MR. BENJAMIN PARSONS
Title or Position: CFO
Credential:
Phone: 216-772-1105