Healthcare Provider Details

I. General information

NPI: 1518485820
Provider Name (Legal Business Name): EDGEWOOD MANOR OF WESTERVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N STATE ST
WESTERVILLE OH
43081-1426
US

IV. Provider business mailing address

270 MADISON AVE FL 17
NEW YORK NY
10016-0601
US

V. Phone/Fax

Practice location:
  • Phone: 614-882-4055
  • Fax:
Mailing address:
  • Phone: 212-532-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: EPHRAM LAHASKY
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 212-532-5550