MEDICARE: MV 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	:	1831595503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MV SNF, LLC

Provider Business Mailing Address
First Line	:	83 HIGH ST
Second Line	:
City	:	SEVILLE
State	:	OH
Zip	:	44273-9308
Country	:	US
Telephone Number	:	330-769-2015
Fax Number	:	330-769-3790

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	:	330-769-3790

Authorized Official
Title or Position	:	MANAGER
Name	:	BRUCE E WERTHEIM
Credential	:
Telephone Number	:	914-319-7204

Provider Enumeration Date	:	11/07/2014
Last Update Date	:	01/08/2015

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