1962459024 NPI number — MEDINA VILLAGE RETIREMENT COMMUNITY, LTD

Table of content: (NPI 1962459024)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962459024 NPI number — MEDINA VILLAGE RETIREMENT COMMUNITY, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDINA 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:
MEDINA 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:
1962459024
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:
555 SPRINGBROOK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDINA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44256-3651
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-725-3398
Provider Business Mailing Address Fax Number:
330-350-5144

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 SPRINGBROOK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEDINA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44256-3651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-725-3393
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2006

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

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

  • Identifier: 2601312 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com