MEDICARE: ABBEYVILLE HOUSE

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	315P00000X	Intellectual Disabilities Intermediate Care Facility	5210186	OH

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235129586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABBEYVILLE HOUSE

Provider Business Mailing Address
First Line	:	791 PEARL RD
Second Line	:	P.O. BOX 810
City	:	BRUNSWICK
State	:	OH
Zip	:	44212-2528
Country	:	US
Telephone Number	:	330-273-5494
Fax Number	:	330-273-6199

Provider Business Practice Location Address
First Line	:	2525 ABBEYVILLE RD
Second Line	:
City	:	VALLEY CITY
State	:	OH
Zip	:	44280-9734
Country	:	US
Telephone Number	:	330-273-5494
Fax Number	:	330-273-6199

Authorized Official
Title or Position	:	ADMINISTRATOR PRESIDENT
Name	:	MS. DENISE TRIVANOVICH POZDERAC
Credential	:	LNHA
Telephone Number	:	330-273-5494

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	07/12/2007

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Directions to “ABBEYVILLE HOUSE ” Practice Location

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