Provider Demographics
NPI:1467600726
Name:LAGRANGE NURSING & REHABILITATION CENTER, INC.
Entity Type:Organization
Organization Name:LAGRANGE NURSING & REHABILITATION CENTER, INC.
Other - Org Name:KEYSTONE POINTE HEALTH & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTIERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-936-7158
Mailing Address - Street 1:6967 DEER TRAIL AVE NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44721-2069
Mailing Address - Country:US
Mailing Address - Phone:330-936-7158
Mailing Address - Fax:
Practice Address - Street 1:383 OPPORTUNITY WAY
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:OH
Practice Address - Zip Code:44050-9019
Practice Address - Country:US
Practice Address - Phone:440-355-4616
Practice Address - Fax:440-355-4616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2521N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2903120Medicaid
OH366372Medicare Oscar/Certification