Provider Demographics
NPI:1245052174
Name:CANTON CARE OPERATIONS, LLC
Entity type:Organization
Organization Name:CANTON CARE OPERATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:POHLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-291-7391
Mailing Address - Street 1:1435 COIT AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-4905
Mailing Address - Country:US
Mailing Address - Phone:616-291-7391
Mailing Address - Fax:
Practice Address - Street 1:3660 GREENTREE AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44706-4024
Practice Address - Country:US
Practice Address - Phone:330-484-5888
Practice Address - Fax:330-484-5246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility