Provider Demographics
NPI:1093094880
Name:HAMPTONWOODS ASSISTED LIVING
Entity Type:Organization
Organization Name:HAMPTONWOODS ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTALOCY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-792-7681
Mailing Address - Street 1:4780 KIRK RD
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-5403
Mailing Address - Country:US
Mailing Address - Phone:330-792-7681
Mailing Address - Fax:330-792-9282
Practice Address - Street 1:1525 E WESTERN RESERVE RD
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-3254
Practice Address - Country:US
Practice Address - Phone:330-707-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2457R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH366329Medicare Oscar/Certification