=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972391795
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OHIO VALLEY MANOR OPCO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2025
-----------------------------------------------------
Last Update Date | 12/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5280 HIGHWAY 62 # 68
-----------------------------------------------------
City | RIPLEY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45167-8650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-620-7828
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5910 LANDERBROOK DR STE 150
-----------------------------------------------------
City | MAYFIELD HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44124-6506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF OPERATING OFFICER
-----------------------------------------------------
Name | JEFFREY DEGYANSKY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-620-7828
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------