MEDICARE: CANTON CHRISTIAN HOME, 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	1618N	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
2	1618N	OTHER	OH	STATE LICENSE NUMBER
3	1618R	OTHER	OH	RESCARE

General Provider Information

NPI Number	:	1982605507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANTON CHRISTIAN HOME, INC

Provider Business Mailing Address
First Line	:	2550 CLEVELAND AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44709-3306
Country	:	US
Telephone Number	:	330-456-0004
Fax Number	:	330-452-9951

Provider Business Practice Location Address
First Line	:	2550 CLEVELAND AVE NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44709-3306
Country	:	US
Telephone Number	:	330-456-0004
Fax Number	:	330-452-9951

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. THOMAS STROBL
Credential	:
Telephone Number	:	330-456-0004

Provider Enumeration Date	:	08/04/2005
Last Update Date	:	07/01/2015

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Directions to “CANTON CHRISTIAN HOME, INC ” Practice Location

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