MEDICARE: ST. JOSEPH CARE CENTER

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	310400000X	Assisted Living Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1587R	OTHER	OH	OHIO DEPARTMENT OF HEALTH

General Provider Information

NPI Number	:	1578155123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. JOSEPH CARE CENTER

Provider Business Mailing Address
First Line	:	2308 RENO DR
Second Line	:
City	:	LOUISVILLE
State	:	OH
Zip	:	44641-9083
Country	:	US
Telephone Number	:	330-875-5562
Fax Number	:	330-875-8947

Provider Business Practice Location Address
First Line	:	2308 RENO DR
Second Line	:
City	:	LOUISVILLE
State	:	OH
Zip	:	44641-9083
Country	:	US
Telephone Number	:	330-875-5562
Fax Number	:	330-875-8947

Authorized Official
Title or Position	:	CEO
Name	:	SUSAN M STRUTNER
Credential	:
Telephone Number	:	330-875-5562

Provider Enumeration Date	:	02/05/2021
Last Update Date	:	02/05/2021

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Directions to “ST. JOSEPH CARE CENTER ” Practice Location

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