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General NPI Number Information
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NPI Number | 1841799012
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Entity Type | Organization
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Legal Business Name | EC OPCO MEDINA, LLC
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Dates
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Enumeration Date | 02/02/2018
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Last Update Date | 03/12/2019
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Provider Practice Location Address
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Address Line | 1046 N JEFFERSON ST
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City | MEDINA
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State | OH
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Zip | 44256-1102
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Country | US
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Telephone | 330-721-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 5885 MEADOWS RD STE 500
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-8646
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Country | US
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Telephone | 971-254-1368
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Fax |
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Authorized Official
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Title or Position | CONTROLLER
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Name | AMY W. FLEMING
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Credential |
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Telephone | 971-337-3922
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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 |
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License Number State | OH
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