1477539070 NPI number — NORTHFIELD VILLAGE RETIREMENT COMMUNITY, LTD.

Table of content: (NPI 1477539070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477539070 NPI number — NORTHFIELD VILLAGE RETIREMENT COMMUNITY, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHFIELD VILLAGE RETIREMENT COMMUNITY, LTD.
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:
NORTHFIELD VILLAGE SKILLED NURSING AND REHABILITATION
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:
1477539070
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10267 NORTHFIELD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44067-1418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-468-1800
Provider Business Mailing Address Fax Number:
330-468-2666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10267 NORTHFIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44067-1418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-468-1800
Provider Business Practice Location Address Fax Number:
330-342-4719
Provider Enumeration Date:
12/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FRANCUS
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRES., VRC, INC MANAGER
Authorized Official Telephone Number:
330-929-0009

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  2385N , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2410886 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2385N . This is a "NURSING FACILITY" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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