Provider Demographics
NPI:1588668305
Name:COUNTY OF ASHTABULA
Entity Type:Organization
Organization Name:COUNTY OF ASHTABULA
Other - Org Name:ASHTABULA COUNTY NURSING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:440-224-2161
Mailing Address - Street 1:5740 DIBBLE RD
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44048-9809
Mailing Address - Country:US
Mailing Address - Phone:440-224-2161
Mailing Address - Fax:440-224-2166
Practice Address - Street 1:5740 DIBBLE RD
Practice Address - Street 2:
Practice Address - City:KINGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44048-9809
Practice Address - Country:US
Practice Address - Phone:440-224-2161
Practice Address - Fax:440-224-2166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHN/A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0237836Medicaid
OH365741Medicare ID - Type Unspecified