Organization
COMMUNITY SKILLED NURSING CENTRE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAYMOND DECRISTOFARO CPA (CFO)
(330) 373-1160
Entity
Organization
Contact information
Practice address
1320 MAHONING AVE NW, WARREN, OH 44483-2002
(330) 373-1160
(330) 392-3649
Mailing address
1320 MAHONING AVE NW, WARREN, OH 44483-2002
(330) 373-1160
(330) 392-3649
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2864
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000157102
ANTHEM INSURANCE PRODUCTS
OH
05
—
0391571
—
OH
Enumeration date
07/22/2006
Last updated
08/23/2012
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