Organization
EXTENDICARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTHONY WILLIAM LONG MPT (PT)
(614) 432-6665
Entity
Organization
Contact information
Practice address
375 W MAIN ST, WEST JEFFERSON, OH 43162-1298
(614) 879-7661
(614) 879-7604
Mailing address
375 W MAIN ST, WEST JEFFERSON, OH 43162-1298
(614) 879-7661
(614) 879-7604
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
9979
OH
Other
Enumeration date
11/15/2013
Last updated
11/15/2013
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