MEDICARE: 3102 SAINT CHARLES DRIVE OPERATING COMPANY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	1494N	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063409522
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	3102 SAINT CHARLES DRIVE OPERATING COMPANY, INC.

Provider Business Mailing Address
First Line	:	3102 SAINT CHARLES DR
Second Line	:
City	:	STEUBENVILLE
State	:	OH
Zip	:	43952-3508
Country	:	US
Telephone Number	:	740-264-7161
Fax Number	:	740-264-7116

Provider Business Practice Location Address
First Line	:	3102 SAINT CHARLES DR
Second Line	:
City	:	STEUBENVILLE
State	:	OH
Zip	:	43952-3508
Country	:	US
Telephone Number	:	740-264-7161
Fax Number	:	740-264-7116

Authorized Official
Title or Position	:	AR DIRECTOR
Name	:	MRS. JANA L SMITH
Credential	:
Telephone Number	:	937-277-0505

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	05/09/2012

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