1366266454 NPI number — SAYBROOK ASSISTED LIVING LLC

Table of content: (NPI 1366266454)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366266454 NPI number — SAYBROOK ASSISTED LIVING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAYBROOK ASSISTED LIVING 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:
Provider Other Organization Name Type Code:
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:
1366266454
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1419 BOARDMAN-CANFIELD ROAD
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
BOARDMAN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44512-8071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-726-5790
Provider Business Mailing Address Fax Number:
330-726-5792

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43171 COUNTY LINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIANA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44408-9394
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-892-3200
Provider Business Practice Location Address Fax Number:
330-892-3299
Provider Enumeration Date:
11/14/2024

Additional Information

Authorized Official

Authorized Official Last Name:
RUPEKA
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
330-726-5790

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2998R . This is a "OHIO DEPARTMENT OF HEALTH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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