Healthcare Provider Details

I. General information

NPI: 1457744013
Provider Name (Legal Business Name): SKILLSMED INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2015
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1156 W WESTERN RESERVE RD
YOUNGSTOWN OH
44514-3542
US

IV. Provider business mailing address

1156 W WESTERN RESERVE RD
YOUNGSTOWN OH
44514-3542
US

V. Phone/Fax

Practice location:
  • Phone: 330-629-2919
  • Fax: 330-629-2915
Mailing address:
  • Phone: 330-629-2919
  • Fax: 330-629-2915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: CARLA CLARK
Title or Position: C.E.O.
Credential:
Phone: 330-207-7355