Provider Demographics
NPI:1992034557
Name:SALEM HEALTHCARE AND REHABILITATION CENTER
Entity type:Organization
Organization Name:SALEM HEALTHCARE AND REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:NIELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:407-247-2788
Mailing Address - Street 1:1985 EAST PERSHING STREET
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OH
Mailing Address - Zip Code:44460-3411
Mailing Address - Country:US
Mailing Address - Phone:330-332-1588
Mailing Address - Fax:330-332-3119
Practice Address - Street 1:1985 E PERSHING ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-3411
Practice Address - Country:US
Practice Address - Phone:330-332-1588
Practice Address - Fax:330-332-3119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-10
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1140-N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2987148Medicaid
365977Medicare Oscar/Certification