Provider Demographics
NPI:1144233057
Name:CARLTON MANOR NURSING & REHABILITATION CENTER, INC.
Entity Type:Organization
Organization Name:CARLTON MANOR NURSING & REHABILITATION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:SMILOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:216-289-4400
Mailing Address - Street 1:726 RAWLINGS ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-1518
Mailing Address - Country:US
Mailing Address - Phone:740-335-7143
Mailing Address - Fax:740-335-3888
Practice Address - Street 1:726 RAWLINGS ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-1518
Practice Address - Country:US
Practice Address - Phone:740-335-7143
Practice Address - Fax:740-335-3888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1311N313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2381471Medicaid
OH2381471Medicaid