Provider Demographics
NPI:1043895360
Name:PARK VISTA SNF OPS, LLC
Entity Type:Organization
Organization Name:PARK VISTA SNF OPS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHLOMO
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-746-2944
Mailing Address - Street 1:1216 5TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1605
Mailing Address - Country:US
Mailing Address - Phone:330-746-2944
Mailing Address - Fax:330-746-3427
Practice Address - Street 1:1216 5TH AVENUE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1605
Practice Address - Country:US
Practice Address - Phone:330-746-2944
Practice Address - Fax:330-746-3427
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARK VISTA SNF OPS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0422048Medicaid