Provider Demographics
NPI:1295836781
Name:ESSEX HEALTHCARE CORPORATION
Entity Type:Organization
Organization Name:ESSEX HEALTHCARE CORPORATION
Other - Org Name:CANTON HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:YODER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-416-2662
Mailing Address - Street 1:2 EASTON OVAL
Mailing Address - Street 2:SUITE 210
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-6036
Mailing Address - Country:US
Mailing Address - Phone:330-454-2152
Mailing Address - Fax:
Practice Address - Street 1:1223 MARKET AVE N
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44714-2603
Practice Address - Country:US
Practice Address - Phone:330-454-2152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1084N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2024811Medicaid
OH2024811Medicaid