Provider Demographics
NPI:1043200546
Name:HORN RETIREMENT VILLAGE, INC.
Entity Type:Organization
Organization Name:HORN RETIREMENT VILLAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP AND CIO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-989-5234
Mailing Address - Street 1:230 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-3512
Mailing Address - Country:US
Mailing Address - Phone:330-262-2951
Mailing Address - Fax:330-264-1254
Practice Address - Street 1:230 N MARKET ST
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-3512
Practice Address - Country:US
Practice Address - Phone:330-262-2951
Practice Address - Fax:330-264-1254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5548314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000357113OtherANTHEM PT
OH000000357115OtherANTHEM OT
OH000000357116OtherANTHEM ST
OH2265285Medicaid
OH000000156456OtherANTHEM
OH2265285Medicaid
OH=========002OtherMEDICAL MUTUAL
OH4971120001Medicare NSC