Healthcare Provider Details

I. General information

NPI: 1790603652
Provider Name (Legal Business Name): BD MEDINA SOUTH OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HIGH POINT DR
MEDINA OH
44256-4360
US

IV. Provider business mailing address

12800 N MERIDIAN ST STE 100
CARMEL IN
46032-9437
US

V. Phone/Fax

Practice location:
  • Phone: 330-723-0110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: SHANNON RINEARSON
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 317-641-0418