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General NPI Number Information
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NPI Number | 1609253830
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Entity Type | Organization
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Legal Business Name | ASTORIA PLACE OF CLYDE LLC
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Dates
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Enumeration Date | 04/27/2015
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Last Update Date | 04/27/2015
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Provider Practice Location Address
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Address Line | 700 HELEN ST
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City | CLYDE
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State | OH
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Zip | 43410-2051
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Country | US
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Telephone | 419-547-9595
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Fax | 419-547-7870
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Provider Business Mailing Address
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Address Line | 700 HELEN ST
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City | CLYDE
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State | OH
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Zip | 43410-2051
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Country | US
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Telephone | 419-547-9595
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Fax | 419-547-7870
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Authorized Official
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Title or Position | ATTORNEY
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Name | HAYLEY B WILLIAMS
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Credential |
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Telephone | 216-706-3936
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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 | 1715N
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License Number State | OH
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