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General NPI Number Information
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NPI Number | 1245227941
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Entity Type | Organization
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Legal Business Name | STEUBENVILLE COUNTRY CLUB MANOR
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Dates
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Enumeration Date | 09/29/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 575 LOVERS LN
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City | STEUBENVILLE
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State | OH
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Zip | 43953-3311
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Country | US
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Telephone | 740-266-6118
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Fax | 740-264-8898
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Provider Business Mailing Address
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Address Line | 575 LOVERS LN
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City | STEUBENVILLE
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State | OH
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Zip | 43953-3311
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Country | US
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Telephone | 740-266-6118
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Fax | 740-264-8898
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JAMES J BOLGER
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Credential |
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Telephone | 740-266-6118
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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 | 6136
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License Number State | OH
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