Provider Demographics
NPI:1437213964
Name:EAST CARROLL NURSING HOME INC
Entity Type:Organization
Organization Name:EAST CARROLL NURSING HOME INC
Other - Org Name:COUNTRYVIEW MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:330-627-6900
Mailing Address - Street 1:2193 COMMERCE DRIVE
Mailing Address - Street 2:COUNTRYVIEW MANOR
Mailing Address - City:CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:44615
Mailing Address - Country:US
Mailing Address - Phone:330-627-6900
Mailing Address - Fax:330-627-9036
Practice Address - Street 1:2193 COMMERCE DRIVE
Practice Address - Street 2:COUNTRYVIEW MANOR
Practice Address - City:CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:44615
Practice Address - Country:US
Practice Address - Phone:330-627-6900
Practice Address - Fax:330-627-9036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2443N315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2654122Medicaid
OH2654122Medicaid