Provider Demographics
NPI:1487294625
Name:TITAN SENQUEST
Entity type:Organization
Organization Name:TITAN SENQUEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMISSIONS
Authorized Official - Prefix:
Authorized Official - First Name:BEV
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-336-3616
Mailing Address - Street 1:250 SMOKERISE DR
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8210
Mailing Address - Country:US
Mailing Address - Phone:330-336-3616
Mailing Address - Fax:330-336-9173
Practice Address - Street 1:250 SMOKERISE DR
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8210
Practice Address - Country:US
Practice Address - Phone:330-336-3616
Practice Address - Fax:330-336-9173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH533374544Medicaid