Provider Demographics
NPI:1790787968
Name:CANTERBURY VILLA OPERATIONS CORP
Entity Type:Organization
Organization Name:CANTERBURY VILLA OPERATIONS CORP
Other - Org Name:CANTERBURY VILLA OF ALLIANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLERAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-793-2245
Mailing Address - Street 1:25000 COUNTRY CLUB BLVD STE 255
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-5337
Mailing Address - Country:US
Mailing Address - Phone:440-793-2245
Mailing Address - Fax:
Practice Address - Street 1:1785 N FRESHLEY AVE
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-8772
Practice Address - Country:US
Practice Address - Phone:330-821-4000
Practice Address - Fax:330-821-6127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1774N314000000X
OH1774332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Not Answered332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2450824Medicaid
OH366214Medicare ID - Type Unspecified
OH2450824Medicaid