Provider Demographics
NPI:1457359432
Name:BOYD'S KINSMAN HOME, INC.
Entity type:Organization
Organization Name:BOYD'S KINSMAN HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUBY
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA, QMRP
Authorized Official - Phone:330-876-5581
Mailing Address - Street 1:PO BOX 315
Mailing Address - Street 2:7929 STATE ROUTE #5
Mailing Address - City:KINSMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44428-0315
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:330-876-8804
Practice Address - Street 1:7929 STATE ROUTE #5
Practice Address - Street 2:
Practice Address - City:KINSMAN
Practice Address - State:OH
Practice Address - Zip Code:44428-0315
Practice Address - Country:US
Practice Address - Phone:330-876-5581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7810042315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0314047Medicaid