Basic Information
| Provider Information | |||||||||
| NPI: | 1326039744 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OHIO EXTENDED CARE CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3364 KOLBE RD | ||||||||
| Address2: | |||||||||
| City: | LORAIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440531628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402822244 | ||||||||
| FaxNumber: | 4402827709 | ||||||||
| Practice Location | |||||||||
| Address1: | 3364 KOLBE RD | ||||||||
| Address2: | |||||||||
| City: | LORAIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440531628 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402822244 | ||||||||
| FaxNumber: | 4402827709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DOHERTY | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4402822244 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 365623 | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.