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General NPI Number Information
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NPI Number | 1235925439
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Entity Type | Organization
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Legal Business Name | SJCC OPCO-ILALMC
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Dates
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Enumeration Date | 04/16/2025
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 2308 RENO DR
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City | LOUISVILLE
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State | OH
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Zip | 44641-9083
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Country | US
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Telephone | 330-875-5562
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Fax | 330-875-8947
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Provider Business Mailing Address
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Address Line | 811 S MAIN ST
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City | NORTH CANTON
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State | OH
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Zip | 44720-3156
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Country | US
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Telephone | 330-838-0058
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDY HARPSTER
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Credential |
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Telephone | 330-838-0058
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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 |
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License Number State |
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