Provider Demographics
NPI:1285298166
Name:CENTREVILLE VILLAGE OF CARROLL COUNTY
Entity type:Organization
Organization Name:CENTREVILLE VILLAGE OF CARROLL COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNA
Authorized Official - Suffix:
Authorized Official - Credentials:CEAL
Authorized Official - Phone:330-627-7070
Mailing Address - Street 1:1082 KENSINGTON RD NE
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:44615-9403
Mailing Address - Country:US
Mailing Address - Phone:330-627-7070
Mailing Address - Fax:330-627-6209
Practice Address - Street 1:1082 KENSINGTON RD NE
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:44615-9403
Practice Address - Country:US
Practice Address - Phone:330-627-7070
Practice Address - Fax:330-627-6209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility