Provider Demographics
NPI:1235925439
Name:SJCC OPCO-ILALMC
Entity type:Organization
Organization Name:SJCC OPCO-ILALMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-838-0058
Mailing Address - Street 1:811 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-3156
Mailing Address - Country:US
Mailing Address - Phone:330-838-0058
Mailing Address - Fax:
Practice Address - Street 1:2308 RENO DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:44641-9083
Practice Address - Country:US
Practice Address - Phone:330-875-5562
Practice Address - Fax:330-875-8947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility