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NPI Code Detail

MEDICARE: HARBORSIDE SWANTON, LLC

MEDICARE: HARBORSIDE SWANTON, LLC
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
1314000000XSkilled Nursing Facility4908OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1861509499
Entity Type Code : Organization
Provider Name (Legal Business Name) : HARBORSIDE SWANTON, LLC
Provider Business Mailing Address
First Line : 101 SUN AVE NE
Second Line : COMPLIANCE DEPARTMENT
City : ALBUQUERQUE
State : NM
Zip : 87109-4373
Country : US
Telephone Number : 505-468-5604
Fax Number : 505-468-4681
Provider Business Practice Location Address
First Line : 401 W AIRPORT HWY
Second Line :
City : SWANTON
State : OH
Zip : 43558-1445
Country : US
Telephone Number : 419-825-1111
Fax Number : 419-825-2233
Authorized Official
Title or Position : PRESIDENT DIRECTOR
Name : WILLIAM A MATHIES
Credential :
Telephone Number : 505-821-3355
Provider Enumeration Date : 08/23/2006
Last Update Date : 10/01/2009

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Directions to “HARBORSIDE SWANTON, LLC ” Practice Location

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