Provider Demographics
NPI:1689613523
Name:HENNIS CARE CENTRE OF DOVER INC.
Entity Type:Organization
Organization Name:HENNIS CARE CENTRE OF DOVER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:ACCOUNTANT
Authorized Official - Phone:330-364-8849
Mailing Address - Street 1:1720 N CROSS ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-1043
Mailing Address - Country:US
Mailing Address - Phone:330-364-8849
Mailing Address - Fax:330-364-9158
Practice Address - Street 1:1720 N CROSS ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-1043
Practice Address - Country:US
Practice Address - Phone:330-364-8849
Practice Address - Fax:330-364-9158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1645R310400000X
OH1645N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2277316Medicaid
OH365838Medicare Oscar/Certification