204 W. Main Street Operating Company, LLC
NPI #1457463556 in New London, Ohio
Provider Information
- NPI Number
- 1457463556
- Entity Type
- Organization
- Organization Name
- 204 W. Main Street Operating Company, LLC
- Primary Specialty
- Skilled Nursing Facility
- Enumeration Date
- Aug 31, 2006
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 204 W MAIN ST
- City
- New London
- State
- Ohio
- ZIP Code
- 44851-1070
- Phone
- (419) 929-1563
Authorized Official
- Name
- MR. KEVIN P BRESLIN
- Title
- EXECUTIVE VICE PRESIDENT - CFO
- Phone
- (201) 242-4000
Specialties & Taxonomy Codes
| Specialty |
|---|
| Skilled Nursing Facility |
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