Organization
COUNTRY CLUB CENTER HOMES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL M HOHMAN (ADMINISTRATOR)
(330) 343-5568
Entity
Organization
Contact information
Practice address
860 E IRON AVE, DOVER, OH 44622-2031
(330) 343-5568
(330) 343-0514
Mailing address
860 E IRON AVE, DOVER, OH 44622-2031
(330) 343-5568
(330) 343-0514
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2499
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0400828
—
OH
Enumeration date
10/17/2006
Last updated
08/22/2020
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