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General NPI Number Information
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NPI Number | 1629674940
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Entity Type | Organization
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Legal Business Name | THE VILLAGE OF ST. EDWARD AT WADSWORTH
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Dates
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Enumeration Date | 12/10/2020
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Last Update Date | 12/16/2020
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Provider Practice Location Address
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Address Line | 880 MAIN ST
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City | WADSWORTH
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State | OH
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Zip | 44281-1583
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Country | US
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Telephone | 234-217-8735
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Fax |
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Provider Business Mailing Address
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Address Line | 3131 SMITH RD
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City | FAIRLAWN
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State | OH
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Zip | 44333-2613
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Country | US
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Telephone | 234-466-5210
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | DANIELLE MARIE MAUR
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Credential |
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Telephone | 234-466-5210
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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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