Provider Demographics
NPI:1710235825
Name:HAVEN SKILLED CARE OF CANTON LLC
Entity Type:Organization
Organization Name:HAVEN SKILLED CARE OF CANTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:SPALEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:234-312-4980
Mailing Address - Street 1:11366 CLEVELAND AVE NW
Mailing Address - Street 2:STE B
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-8078
Mailing Address - Country:US
Mailing Address - Phone:330-305-6699
Mailing Address - Fax:330-305-6856
Practice Address - Street 1:150 N MILLER RD STE 350A
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3779
Practice Address - Country:US
Practice Address - Phone:330-305-6699
Practice Address - Fax:330-305-6856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-21
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH093780Medicaid
OH368256Medicare Oscar/Certification