Provider Demographics
NPI:1376628230
Name:CANTON CHRISTIAN HOME
Entity Type:Organization
Organization Name:CANTON CHRISTIAN HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:A.
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:STROBL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-456-0004
Mailing Address - Street 1:2550 CLEVELAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-3306
Mailing Address - Country:US
Mailing Address - Phone:330-456-0004
Mailing Address - Fax:330-452-9951
Practice Address - Street 1:2550 CLEVELAND AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3306
Practice Address - Country:US
Practice Address - Phone:330-456-0004
Practice Address - Fax:330-452-9951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1618N313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0345237Medicaid
OH36-6300Medicare ID - Type Unspecified