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General NPI Number Information
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NPI Number | 1407843931
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Entity Type | Organization
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Legal Business Name | LISBON SKILLED NURSING AND RESIDENTIAL CARE, LLC
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Dates
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Enumeration Date | 09/30/2005
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Last Update Date | 01/26/2023
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Provider Practice Location Address
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Address Line | 100 VISTA DR
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City | LISBON
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State | OH
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Zip | 44432-1008
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Country | US
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Telephone | 330-424-5852
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Fax |
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Provider Business Mailing Address
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Address Line | 2875 CENTER RD STE 6
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City | BRUNSWICK
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State | OH
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Zip | 44212-2319
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Country | US
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Telephone | 216-772-1105
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Fax |
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Authorized Official
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Title or Position | SECRETARY
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Name | MR. BENJAMIN PARSONS
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Credential |
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Telephone | 216-772-1105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 2090R
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 2090N
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License Number State | OH
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