Provider Demographics
NPI:1003978073
Name:ECHOING HILLS VILLAGE, INC.
Entity Type:Organization
Organization Name:ECHOING HILLS VILLAGE, INC.
Other - Org Name:ECHOING LAKE - ENGRAM GROUP HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-327-2311
Mailing Address - Street 1:36272 COUNTY ROAD 79
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:OH
Mailing Address - Zip Code:43844-9770
Mailing Address - Country:US
Mailing Address - Phone:740-327-2311
Mailing Address - Fax:740-327-6371
Practice Address - Street 1:175 CHADWICK CT
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-4669
Practice Address - Country:US
Practice Address - Phone:440-323-0915
Practice Address - Fax:440-323-7418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4710647315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0936894Medicaid
OH9452OtherOHIO DEPT OF HEALTH NO.
OH36-G477Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO.