Basic Information
| Provider Information | |||||||||
| NPI: | 1689871477 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OAK HILLS NURSING CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 32220 ELECTRIC BLVD | ||||||||
| Address2: | |||||||||
| City: | AVON LAKE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440121826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4409333222 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3650 BEAVERCREST DR | ||||||||
| Address2: | |||||||||
| City: | LORAIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440531710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402829171 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2007 | ||||||||
| LastUpdateDate: | 07/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | BUCHANAN | ||||||||
| AuthorizedOfficialFirstName: | VERONICA | ||||||||
| AuthorizedOfficialMiddleName: | GWYN | ||||||||
| AuthorizedOfficialTitleorPosition: | SPEECH LANGUAGE PATHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 4402829171 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MACCCSLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3140N1450X | 5199 | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility | Nursing Care, Pediatric |
ID Information
| ID | Type | State | Issuer | Description | 5199 | 01 | OH | SPEECH THERAPT LICENSE | OTHER |