=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851446371
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALTERCARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2007
-----------------------------------------------------
Last Update Date | 08/26/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 35990 WESTMINISTER AVE
-----------------------------------------------------
City | NORTH RIDGEVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44039-1373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-327-8511
-----------------------------------------------------
Fax | 440-327-8798
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35990 WESTMINISTER AVE
-----------------------------------------------------
City | NORTH RIDGEVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44039-1373
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-327-8511
-----------------------------------------------------
Fax | 440-327-8598
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ROBERT A. WICKES
-----------------------------------------------------
Credential | DVM
-----------------------------------------------------
Telephone | 330-468-1200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 3546
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------