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General NPI Number Information
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NPI Number | 1689613523
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Entity Type | Organization
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Legal Business Name | HENNIS CARE CENTRE OF DOVER INC.
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 01/11/2012
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Provider Practice Location Address
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Address Line | 1720 N CROSS ST
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City | DOVER
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State | OH
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Zip | 44622-1043
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Country | US
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Telephone | 330-364-8849
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Fax | 330-364-9158
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Provider Business Mailing Address
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Address Line | 1720 N CROSS ST
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City | DOVER
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State | OH
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Zip | 44622-1043
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Country | US
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Telephone | 330-364-8849
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Fax | 330-364-9158
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Authorized Official
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Title or Position | CONTROLLER
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Name | MR. HAROLD D BAKER
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Credential | ACCOUNTANT
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Telephone | 330-364-8849
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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 | 1645R
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 1645N
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License Number State | OH
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