Basic Information
| Provider Information | |||||||||
| NPI: | 1043294390 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SACRED HEART NURSING CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 60 WEST ST | ||||||||
| Address2: | |||||||||
| City: | GENEVA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440419723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4404661181 | ||||||||
| FaxNumber: | 4404669165 | ||||||||
| Practice Location | |||||||||
| Address1: | 60 WEST ST | ||||||||
| Address2: | |||||||||
| City: | GENEVA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440419723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4404661181 | ||||||||
| FaxNumber: | 4404669165 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KNOWLSON | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4404661181 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 365962 | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 2292102 | 05 | OH | MEDICAID |