MEDICARE: ALS MOUNT VERNON 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	2630N	OH

General Provider Information

NPI Number	:	1275056491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALS MOUNT VERNON LLC

Provider Business Mailing Address
First Line	:	5910 LANDERBROOK DR STE 150
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-6506
Country	:	US
Telephone Number	:	330-350-0379
Fax Number	:

Provider Business Practice Location Address
First Line	:	1135 GAMBIER RD
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-3839
Country	:	US
Telephone Number	:	740-392-1099
Fax Number	:	740-392-2412

Authorized Official
Title or Position	:	VP OF OPERATIONS
Name	:	JEFF DEGYANSKY
Credential	:
Telephone Number	:	330-620-7828

Provider Enumeration Date	:	07/19/2017
Last Update Date	:	12/04/2025

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Directions to “ALS MOUNT VERNON LLC ” Practice Location

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