Healthcare Provider Details

I. General information

NPI: 1710071162
Provider Name (Legal Business Name): SHEPHERD OF THE VALLEY LUTHERAN RETIREMENT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 TIBBETTS WICK RD
GIRARD OH
44420-1206
US

IV. Provider business mailing address

5525 SILICA ROAD
AUSTINTOWN OH
44515-1002
US

V. Phone/Fax

Practice location:
  • Phone: 330-544-0771
  • Fax:
Mailing address:
  • Phone: 330-530-4038
  • Fax: 330-530-4039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA BROWN
Title or Position: CFO
Credential:
Phone: 330-530-4038