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General NPI Number Information
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NPI Number | 1033247085
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Entity Type | Organization
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Legal Business Name | COMMUNITY COMMONS
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1340 MAHONING AVE NW
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City | WARREN
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State | OH
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Zip | 44483-2084
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Country | US
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Telephone | 330-394-3037
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Fax | 330-395-0017
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Provider Business Mailing Address
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Address Line | 1340 MAHONING AVE NW
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City | WARREN
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State | OH
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Zip | 44483-2084
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Country | US
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Telephone | 330-394-3037
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Fax | 330-395-0017
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. CHRISTY G BOONE
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Credential | LNHA
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Telephone | 330-394-3037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 6361
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License Number State | OH
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