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NPI Code Detail

MEDICARE: BUCKEYE FOREST AT CANTON LLC

MEDICARE: BUCKEYE FOREST AT CANTON LLC
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
1314000000XSkilled Nursing Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11585NOTHEROHLICENSURE

General Provider Information

NPI Number : 1124783022
Entity Type Code : Organization
Provider Name (Legal Business Name) : BUCKEYE FOREST AT CANTON LLC
Provider Business Mailing Address
First Line : 50 CHESTNUT RIDGE RD STE 107
Second Line :
City : MONTVALE
State : NJ
Zip : 07645-1823
Country : US
Telephone Number : 908-327-6982
Fax Number :
Provider Business Practice Location Address
First Line : 5005 HIGBEE AVE NW
Second Line :
City : CANTON
State : OH
Zip : 44718-2521
Country : US
Telephone Number : 330-492-7835
Fax Number :
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : LARRY KATZ
Credential :
Telephone Number : 908-327-6982
Provider Enumeration Date : 11/04/2021
Last Update Date : 12/11/2025

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Directions to “BUCKEYE FOREST AT CANTON LLC ” Practice Location

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