Basic Information
| Provider Information | |||||||||
| NPI: | 1831563485 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOARDMAN SKILLED NURSING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7261 ENGLE RD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | MIDDLEBURG HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441308467 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 830 BOARDMAN CANFIELD RD | ||||||||
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| City: | YOUNGSTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445124213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2167721105 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2015 | ||||||||
| LastUpdateDate: | 11/19/2015 | ||||||||
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| AuthorizedOfficialLastName: | PARSONS | ||||||||
| AuthorizedOfficialFirstName: | BENJAMIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | GENERAL COUNSE | ||||||||
| AuthorizedOfficialTelephone: | 2167723192 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.