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General NPI Number Information
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NPI Number | 1902889306
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Entity Type | Organization
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Legal Business Name | ST. EDWARD HOME
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Dates
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Enumeration Date | 11/21/2005
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Last Update Date | 12/28/2020
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Provider Practice Location 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 | 330-666-1183
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Fax | 330-666-2721
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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 | 330-666-1183
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Fax | 330-666-2721
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Authorized Official
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Title or Position | V.P. FINANCE/CFO
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Name | MRS. BRIAN RENKAS
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Credential | CPA
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Telephone | 330-666-1183
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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 | 1181N
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License Number State | OH
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