MEDICARE: GILLETTE NURSING HOME, 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	4321	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	:	1184722522
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GILLETTE NURSING HOME, INC.

Provider Business Mailing Address
First Line	:	3310 ELM RD NE
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44483-2614
Country	:	US
Telephone Number	:	330-372-1960
Fax Number	:	330-372-6132

Provider Business Practice Location Address
First Line	:	3310 ELM RD NE
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44483-2614
Country	:	US
Telephone Number	:	330-372-1960
Fax Number	:	330-372-6132

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MR. DOUGLAS A STEIN
Credential	:
Telephone Number	:	330-372-1960

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	03/15/2012

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