Organization
CAPITAL SENIOR LIVING, ILM-B INC.
Active
Other names
Canton Regency
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KRISTEN JOY GASPER (ACCOUNTING DIRECTOR)
(330) 477-7664
Entity
Organization
Contact information
Practice address
4515 22ND ST NW, CANTON, OH 44708-1573
(330) 477-7664
(330) 478-9645
Mailing address
4515 22ND ST NW, CANTON, OH 44708-1573
(330) 477-7664
(330) 478-9645
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
5977
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000280669
ANTHEM PROVIDER NUMBER
OH
01
—
0005319462
AETNA PROVIDER NUMBER
OH
Enumeration date
09/20/2006
Last updated
01/20/2012
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