Healthcare Provider Details

I. General information

NPI: 1043129661
Provider Name (Legal Business Name): HARVEST GROVE LTC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 MEDINA RD STE 700
MEDINA OH
44256-9335
US

IV. Provider business mailing address

PO BOX 85096
CHICAGO IL
60689-5096
US

V. Phone/Fax

Practice location:
  • Phone: 888-322-6216
  • Fax: 800-258-9178
Mailing address:
  • Phone: 877-791-6772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State

VIII. Authorized Official

Name: ALLISON BROWN
Title or Position: SECRETARY
Credential:
Phone: 502-630-7429