Basic Information
| Provider Information | |||||||||
| NPI: | 1689064487 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | THORNVILLE NH LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THORNVILLE HEALTH AND REHABILITATION CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14100 ZION RD | ||||||||
| Address2: | |||||||||
| City: | THORNVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430769408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402465253 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14100 ZION RD | ||||||||
| Address2: | |||||||||
| City: | THORNVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430769408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402465253 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2015 | ||||||||
| LastUpdateDate: | 09/03/2015 | ||||||||
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| AuthorizedOfficialLastName: | SWARTZ | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT AND CFO | ||||||||
| AuthorizedOfficialTelephone: | 8136359500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 2515N | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 0119337 | 05 | OH | MEDICAID |