Capital Senior Living, Ilm-B Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

5977 Issued in OH

Legal business name

CAPITAL SENIOR LIVING, ILM-B INC.

Doing business as

Canton Regency

Practice address

4515 22ND St NW
Canton, OH 44708-1573

Phone

(330) 477-7664

Fax

(330) 478-9645

NPI assigned

Sep 20, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Kristen Joy Gasper

Title

Accounting Director

Phone

(330) 477-7664

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Canton Regency Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327017600000",
    "number": "1689771826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4515 22ND ST NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447081573",
            "telephone_number": "330-477-7664",
            "fax_number": "330-478-9645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4515 22ND ST NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447081573",
            "telephone_number": "330-477-7664",
            "fax_number": "330-478-9645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAPITAL SENIOR LIVING, ILM-B INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2012-01-20",
        "status": "A",
        "authorized_official_last_name": "GASPER",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_middle_name": "JOY",
        "authorized_official_title_or_position": "ACCOUNTING DIRECTOR",
        "authorized_official_telephone_number": "330-477-7664",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "5977",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER NUMBER",
            "identifier": "000000280669",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER NUMBER",
            "identifier": "0005319462",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canton Regency",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Avi'Xer Card-Tarver

• Skilled Nursing Facility in Canton, OH
• Providers in Canton, OH by specialty
• Skilled Nursing Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.