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General NPI Number Information
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NPI Number | 1669899746
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Entity Type | Organization
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Legal Business Name | KSMS CLEARVIEW LANTERN, LLC
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Dates
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Enumeration Date | 03/26/2014
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Last Update Date | 03/26/2014
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Provider Practice Location Address
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Address Line | 596 CHAMPION AVE W
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City | WARREN
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State | OH
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Zip | 44483-1312
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Country | US
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Telephone | 330-847-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 596 CHAMPION AVE W
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City | WARREN
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State | OH
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Zip | 44483-1312
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Country | US
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Telephone | 330-847-6800
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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 | MR. BRAD WOOD
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Credential |
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Telephone | 317-280-8455
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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 | 2096R
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License Number State | OH
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