1366543837 NPI number — ORION SALEM LLC

Table of content: (NPI 1366543837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366543837 NPI number — ORION SALEM LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORION SALEM LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SALEM SPRINGLAKE CARE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366543837
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 EASTON OVAL
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43219-6061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-416-0600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
509 N HAYDEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42078-8008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-988-4572
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YODER
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
614-416-2662

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  100294 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 12504742 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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