Organization
WAYSIDE FARM INC.
Active
Other names
Wayside Farm Nursing and Rehab Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW W. POOL LNHA (ASSISTANT ADMINISTRATOR)
(330) 923-7828
Entity
Organization
Contact information
Practice address
4557 QUICK RD, PENINSULA, OH 44264-9708
(330) 923-7828
(330) 923-1201
Mailing address
4557 QUICK RD, PENINSULA, OH 44264-9794
(330) 923-7828
(330) 923-1201
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
1279
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0040879
—
OH
Enumeration date
07/10/2006
Last updated
08/22/2020
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