MEDICARE: SHEPHERD OF THE VALLEY LUTHERAN RETIREMENT SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	4706	OH
2	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093808529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHEPHERD OF THE VALLEY LUTHERAN RETIREMENT SERVICES, INC.

Provider Business Mailing Address
First Line	:	5525 SILICA ROAD
Second Line	:
City	:	AUSTINTOWN
State	:	OH
Zip	:	44515-1002
Country	:	US
Telephone Number	:	330-530-4038
Fax Number	:	330-530-4039

Provider Business Practice Location Address
First Line	:	7148 WEST BLVD.
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44512-4336
Country	:	US
Telephone Number	:	330-726-9061
Fax Number	:

Authorized Official
Title or Position	:	ASSOCIATE DIRECTOR/CFO
Name	:	VICTORIA N. BROWN
Credential	:
Telephone Number	:	330-530-4038

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	09/11/2025

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