Healthcare Provider Details

I. General information

NPI: 1689769846
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: 10/04/2006
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 N RIVER RD NE
WARREN OH
44484-1041
US

IV. Provider business mailing address

5525 SILICA RD
AUSTINTOWN OH
44515-1002
US

V. Phone/Fax

Practice location:
  • Phone: 330-856-9232
  • 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 Number6329
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA N. BROWN
Title or Position: ASSOCIATE DIRECTOR/CFO
Credential:
Phone: 330-530-4038