CRG Health Care System, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

34-001344 Issued in OH

Legal business name

CRG HEALTH CARE SYSTEM, INC.

Doing business as

The Manor at Autumn Hills

Practice address

2567 Niles Vienna Rd
Niles, OH 44446-5401

Phone

(330) 652-6745

Fax

(330) 652-8743

NPI assigned

Dec 11, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Carl Russell Gillette, D.O.

Title

Owner, Medical Director

Phone

(330) 652-6745

Specialties & licenses 1

Addresses

Other names 1

• The Manor at Autumn Hills Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1197331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197331200000",
    "number": "1023291200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2567 NILES VIENNA RD",
            "city": "NILES",
            "state": "OH",
            "postal_code": "444465401",
            "telephone_number": "330-652-6745",
            "fax_number": "330-652-8743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2567 NILES VIENNA RD",
            "city": "NILES",
            "state": "OH",
            "postal_code": "444465401",
            "telephone_number": "330-652-6745",
            "fax_number": "330-652-8743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRG HEALTH CARE SYSTEM, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-11",
        "last_updated": "2007-12-11",
        "status": "A",
        "authorized_official_last_name": "GILLETTE",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "OWNER, MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "330-652-6745",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "OH",
            "license": "34-001344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Manor at Autumn Hills",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Niles, OH
• Providers in Niles, OH by specialty
• Assisted Living Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.