Provider Demographics
NPI:1649467648
Name:WINDSOR MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:WINDSOR MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SWALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:330-499-8300
Mailing Address - Street 1:1454 E MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-2634
Mailing Address - Country:US
Mailing Address - Phone:330-499-8300
Mailing Address - Fax:330-966-8300
Practice Address - Street 1:1454 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-2634
Practice Address - Country:US
Practice Address - Phone:330-499-8300
Practice Address - Fax:330-966-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
OH0166N313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0166NOtherNURSING FACILITY LICENSE