MEDICARE: ALTERCARE, 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	3546	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3546	OTHER	OH	OHIO DEPT. OF HEALTH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851446371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTERCARE, INC.

Provider Business Mailing Address
First Line	:	35990 WESTMINISTER AVE
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-1373
Country	:	US
Telephone Number	:	440-327-8511
Fax Number	:	440-327-8598

Provider Business Practice Location Address
First Line	:	35990 WESTMINISTER AVE
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-1373
Country	:	US
Telephone Number	:	440-327-8511
Fax Number	:	440-327-8798

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT A. WICKES
Credential	:	DVM
Telephone Number	:	330-468-1200

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	08/26/2007

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