Provider Demographics
NPI:1043294390
Name:SACRED HEART NURSING CENTER
Entity type:Organization
Organization Name:SACRED HEART NURSING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KNOWLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-466-1181
Mailing Address - Street 1:60 WEST ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:OH
Mailing Address - Zip Code:44041-9723
Mailing Address - Country:US
Mailing Address - Phone:440-466-1181
Mailing Address - Fax:440-466-9165
Practice Address - Street 1:60 WEST ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-9723
Practice Address - Country:US
Practice Address - Phone:440-466-1181
Practice Address - Fax:440-466-9165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH365962314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2292102Medicaid
OH365962Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER