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General NPI Number Information
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NPI Number | 1063433225
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Entity Type | Organization
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Legal Business Name | COMMUNITY SKILLED NURSING CENTRE
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 08/23/2012
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Provider Practice Location Address
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Address Line | 1320 MAHONING AVE NW
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City | WARREN
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State | OH
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Zip | 44483-2002
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Country | US
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Telephone | 330-373-1160
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Fax | 330-392-3649
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Provider Business Mailing Address
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Address Line | 1320 MAHONING AVE NW
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City | WARREN
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State | OH
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Zip | 44483-2002
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Country | US
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Telephone | 330-373-1160
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Fax | 330-392-3649
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Authorized Official
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Title or Position | CFO
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Name | MR. RAYMOND DECRISTOFARO
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Credential | CPA
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Telephone | 330-373-1160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 2864
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License Number State | OH
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