Provider Demographics
NPI:1891286605
Name:SPRINGFIELD CLARK ALF, INC.
Entity Type:Organization
Organization Name:SPRINGFIELD CLARK ALF, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAMICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-856-4232
Mailing Address - Street 1:3001 MIDDLE URBANA RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-9284
Mailing Address - Country:US
Mailing Address - Phone:330-856-4232
Mailing Address - Fax:
Practice Address - Street 1:3001 MIDDLE URBANA RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-9284
Practice Address - Country:US
Practice Address - Phone:937-399-7009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility