Basic Information
| Provider Information | |||||||||
| NPI: | 1609848217 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALTERCARE OF BUCYRUS CENTER FOR REHABILITATION & NURSING CARE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 339 E MAPLE ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NORTH CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447202593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304988101 | ||||||||
| FaxNumber: | 3304988108 | ||||||||
| Practice Location | |||||||||
| Address1: | 1929 WHETSTONE ST | ||||||||
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| City: | BUCYRUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448203564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195627644 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2006 | ||||||||
| LastUpdateDate: | 05/15/2019 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | KATHLEEN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 3304985233 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 6065 | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 2265016 | 05 | OH | MEDICAID |