Healthcare Provider Details

I. General information

NPI: 1528477288
Provider Name (Legal Business Name): SOUTHWOODS REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 08/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7620 SOUTHERN BLVD SUITE 3
BOARDMAN OH
44512-5667
US

IV. Provider business mailing address

7630 SOUTHERN BLVD
BOARDMAN OH
44512-5633
US

V. Phone/Fax

Practice location:
  • Phone: 330-965-9330
  • Fax: 330-965-9311
Mailing address:
  • Phone: 330-729-8001
  • Fax: 330-729-8029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0046AS
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number1485
License Number StateOH
# 6
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. EDWARD MURANSKY
Title or Position: CEO
Credential:
Phone: 330-758-1954