MEDICARE: CANTERBURY VILLA OPERATIONS CORP

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	1774N	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	:	1790787968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANTERBURY VILLA OPERATIONS CORP

Provider Business Mailing Address
First Line	:	25000 COUNTRY CLUB BLVD STE 255
Second Line	:
City	:	NORTH OLMSTED
State	:	OH
Zip	:	44070-5337
Country	:	US
Telephone Number	:	440-793-2245
Fax Number	:

Provider Business Practice Location Address
First Line	:	1785 N FRESHLEY AVE
Second Line	:
City	:	ALLIANCE
State	:	OH
Zip	:	44601-8772
Country	:	US
Telephone Number	:	330-821-4000
Fax Number	:	330-821-6127

Authorized Official
Title or Position	:	CORPORATE SECRETARY
Name	:	SANDY MUIR
Credential	:
Telephone Number	:	440-793-2245

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	06/01/2026

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