Organization
GASLITE VILLA CONVALESCENT CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CORITA C CHILDS LNHA (PRESIDENT)
(330) 854-4545
Entity
Organization
Contact information
Practice address
7055 HIGH MILL AVE NW, CANAL FULTON, OH 44614-9344
(330) 854-4545
(330) 854-6319
Mailing address
7055 HIGH MILL AVE NW, CANAL FULTON, OH 44614-9344
(330) 854-4545
(330) 854-6319
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
001063N
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3089803
—
OH
Enumeration date
07/20/2005
Last updated
08/22/2020
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