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General NPI Number Information
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NPI Number | 1992676993
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Entity Type | Organization
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Legal Business Name | GUSTAVUS SENIOR CARE
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Dates
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Enumeration Date | 09/15/2025
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 8785 YOUNGSTOWN KINGSVILLE RD
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City | FARMDALE
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State | OH
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Zip | 44417-9803
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Country | US
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Telephone | 330-355-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 8785 YOUNGSTOWN KINGSVILLE RD
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City | FARMDALE
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State | OH
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Zip | 44417-9803
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Country | US
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Telephone | 330-355-7000
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Fax |
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Authorized Official
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Title or Position | CHAIRMAN OF BOARD
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Name | ROBERT LESLIE MILLER
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Credential |
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Telephone | 330-876-6573
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number |
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License Number State |
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