MEDICARE: THE CITY HOSPITAL ASSOCIATION

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	365692	OH

General Provider Information

NPI Number	:	1750387429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CITY HOSPITAL ASSOCIATION

Provider Business Mailing Address
First Line	:	425 W FIFTH ST
Second Line	:
City	:	EAST LIVERPOOL
State	:	OH
Zip	:	43920-2405
Country	:	US
Telephone Number	:	330-386-2633
Fax Number	:	330-386-2074

Provider Business Practice Location Address
First Line	:	425 W FIFTH ST
Second Line	:
City	:	EAST LIVERPOOL
State	:	OH
Zip	:	43920-2405
Country	:	US
Telephone Number	:	330-386-2633
Fax Number	:	330-386-2074

Authorized Official
Title or Position	:	VICE PRESIDENT OF FINANCE
Name	:	MR. KYLE D JOHNSON
Credential	:	CPA, FHFME, CHE
Telephone Number	:	330-386-2633

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	07/03/2012

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Directions to “THE CITY HOSPITAL ASSOCIATION ” Practice Location

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