Provider Demographics
NPI:1326010943
Name:ALTERCARE OF MENTOR CENTER FOR REHABILITATION & NURSING CARE, INC.
Entity Type:Organization
Organization Name:ALTERCARE OF MENTOR CENTER FOR REHABILITATION & NURSING CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE/CONTROLLER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-498-5233
Mailing Address - Street 1:339 E MAPLE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-2593
Mailing Address - Country:US
Mailing Address - Phone:330-498-8101
Mailing Address - Fax:330-498-8108
Practice Address - Street 1:9901 JOHNNYCAKE RIDGE RD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6739
Practice Address - Country:US
Practice Address - Phone:440-357-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6079314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2265070Medicaid
OH2265070Medicaid