Healthcare Provider Details

I. General information

NPI: 1831563485
Provider Name (Legal Business Name): BOARDMAN SKILLED NURSING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 BOARDMAN CANFIELD RD
YOUNGSTOWN OH
44512-4213
US

IV. Provider business mailing address

7261 ENGLE RD STE 200
MIDDLEBURG HEIGHTS OH
44130-8467
US

V. Phone/Fax

Practice location:
  • Phone: 216-772-1105
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: BENJAMIN PARSONS
Title or Position: GENERAL COUNSE
Credential:
Phone: 216-772-3192