Provider Demographics
NPI:1477749976
Name:CATHEDRAL ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:CATHEDRAL ASSISTED LIVING, LLC
Other - Org Name:THE INN AT BELDEN VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANETTE
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:GAMMILL
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:330-493-0096
Mailing Address - Street 1:3927 38TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718
Mailing Address - Country:US
Mailing Address - Phone:330-493-0096
Mailing Address - Fax:330-493-9600
Practice Address - Street 1:3927 38TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718
Practice Address - Country:US
Practice Address - Phone:330-493-0096
Practice Address - Fax:330-493-9600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5902310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility