Provider Demographics
NPI:1619017399
Name:PORTAGE COUNTY AUDITOR
Entity Type:Organization
Organization Name:PORTAGE COUNTY AUDITOR
Other - Org Name:THE WOODLANDS AT ROBINSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:330-297-4564
Mailing Address - Street 1:6831 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3929
Mailing Address - Country:US
Mailing Address - Phone:330-297-4564
Mailing Address - Fax:330-298-4530
Practice Address - Street 1:6831 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3929
Practice Address - Country:US
Practice Address - Phone:330-297-4564
Practice Address - Fax:330-298-4530
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PORTAGE COUNTY AUDITOR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-08
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2256026Medicaid
OH2256026Medicaid