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1174149504 NPI number — OAK GROVE MANOR OPERATING COMPANY LLC

NPI Number: 1174149504
Health Care Provider/Practitioner: OAK GROVE MANOR OPERATING COMPANY LLC

Information about “1174149504” NPI (OAK GROVE MANOR OPERATING COMPANY LLC) exists in 1174149504 in HTML format HTML  |  1174149504 in plain Text format TXT  |  1174149504 in PDF (Portable Document Format) PDF  |  1174149504 in an XML format XML  formats.

NPI Number : 1174149504 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1174149504",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "OAK GROVE MANOR OPERATING COMPANY LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5915 LANDERBROOK DR STE 350",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MAYFIELD HEIGHTS",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "44124-4063",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "330-620-7828",
    "MailingAddressFaxNumber": "216-428-2055",
    "FirstLinePracticeLocationAddress": "1670 CRIDER RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MANSFIELD",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "44903-9268",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "419-589-6222",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/22/2020",
    "LastUpdateDate": "12/17/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "DEGYANSKY",
    "AuthorizedOfficialFirstName": "JEFFREY",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "VICE PRESIDENT OF OPERATIONS",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LNHA",
    "AuthorizedOfficialTelephoneNumber": "330-620-7828",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "314000000X",
        "TaxonomyName": "Skilled Nursing Facility",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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