Provider Demographics
NPI:1265476931
Name:AUSTINWOODS NURSING CENTER INC
Entity Type:Organization
Organization Name:AUSTINWOODS NURSING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRAGUE
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 1:4780 KIRK RD
Practice Address - Street 2:
Practice Address - City:AUSTINTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-5403
Practice Address - Country:US
Practice Address - Phone:330-792-7681
Practice Address - Fax:330-792-9282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0057594Medicaid
OH1151330001Medicare NSC
OH365654Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER