Provider Demographics
NPI:1972023844
Name:CARDINAL GAHANNA, INC.
Entity Type:Organization
Organization Name:CARDINAL GAHANNA, INC.
Other - Org Name:CREEKSIDE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTIERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-936-7158
Mailing Address - Street 1:6967 DEER TRAIL AVE NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44721-2069
Mailing Address - Country:US
Mailing Address - Phone:330-936-7158
Mailing Address - Fax:
Practice Address - Street 1:5151 N HAMILTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-1313
Practice Address - Country:US
Practice Address - Phone:614-337-1066
Practice Address - Fax:614-337-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1930N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility