Organization
GOOD SAMARITAN NURSING HOME, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM SHACKLEFORD LNHA (ADMINISTRATOR)
(440) 937-0410
Entity
Organization
Contact information
Practice address
32900 DETROIT RD, AVON, OH 44011-2018
(440) 937-0410
(440) 937-9384
Mailing address
32900 DETROIT RD, AVON, OH 44011-2018
(440) 937-0410
(440) 937-9384
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2339697
—
OH
Enumeration date
06/07/2007
Last updated
08/22/2020
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