MEDICARE: GRACE WOODS SALEM OPCO, 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1750828281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACE WOODS SALEM OPCO, LLC

Provider Business Mailing Address
First Line	:	1166 BENTON RD
Second Line	:
City	:	SALEM
State	:	OH
Zip	:	44460-7623
Country	:	US
Telephone Number	:	330-332-1104
Fax Number	:	330-337-1273

Provider Business Practice Location Address
First Line	:	1166 BENTON RD
Second Line	:
City	:	SALEM
State	:	OH
Zip	:	44460-7623
Country	:	US
Telephone Number	:	330-332-1104
Fax Number	:	330-337-1273

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	BETH A RUSSELL
Credential	:
Telephone Number	:	330-398-0266

Provider Enumeration Date	:	01/23/2017
Last Update Date	:	02/12/2026

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