Provider Demographics
NPI:1720304538
Name:ASTORIA SNF, INC.
Entity Type:Organization
Organization Name:ASTORIA SNF, INC.
Other - Org Name:ASTORIA SKILLED NURSING AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESEDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHESNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-758-4232
Mailing Address - Street 1:3537 12TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-3818
Mailing Address - Country:US
Mailing Address - Phone:330-455-5500
Mailing Address - Fax:330-455-5537
Practice Address - Street 1:3537 12TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-3818
Practice Address - Country:US
Practice Address - Phone:330-455-5500
Practice Address - Fax:330-455-5537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2575N313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3075363Medicaid
OH3075363Medicaid