MEDICARE: MV SEVILLE SNF LLC

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

General Provider Information

NPI Number	:	1235608290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MV SEVILLE SNF LLC

Provider Business Mailing Address
First Line	:	408 VALLEY DR
Second Line	:
City	:	ATTALLA
State	:	AL
Zip	:	35954-1025
Country	:	US
Telephone Number	:	251-583-3972
Fax Number	:	330-595-4344

Provider Business Practice Location Address
First Line	:	83 HIGH ST
Second Line	:
City	:	SEVILLE
State	:	OH
Zip	:	44273-9308
Country	:	US
Telephone Number	:	330-769-2015
Fax Number	:	330-769-1847

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PRENTISS E SMITH III
Credential	:	AUTHORIZED OFFICIAL
Telephone Number	:	251-583-3972

Provider Enumeration Date	:	11/20/2018
Last Update Date	:	01/27/2021

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