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General NPI Number Information
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NPI Number | 1689771826
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Entity Type | Organization
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Legal Business Name | CAPITAL SENIOR LIVING, ILM-B INC.
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 01/20/2012
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Provider Practice Location Address
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Address Line | 4515 22ND ST NW
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City | CANTON
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State | OH
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Zip | 44708-1573
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Country | US
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Telephone | 330-477-7664
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Fax | 330-478-9645
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Provider Business Mailing Address
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Address Line | 4515 22ND ST NW
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City | CANTON
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State | OH
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Zip | 44708-1573
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Country | US
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Telephone | 330-477-7664
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Fax | 330-478-9645
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Authorized Official
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Title or Position | ACCOUNTING DIRECTOR
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Name | MS. KRISTEN JOY GASPER
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Credential |
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Telephone | 330-477-7664
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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 | 5977
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License Number State | OH
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