Provider Demographics
NPI:1053308577
Name:EDJ LLC
Entity Type:Organization
Organization Name:EDJ LLC
Other - Org Name:BRIARFIELD MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/ADMINASTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:J
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-270-3468
Mailing Address - Street 1:461 S CANFIELD NILES RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-4022
Mailing Address - Country:US
Mailing Address - Phone:330-270-3468
Mailing Address - Fax:
Practice Address - Street 1:461 S CANFIELD NILES RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-4022
Practice Address - Country:US
Practice Address - Phone:330-270-3468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0607R310400000X
OH0607N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2438124Medicaid
OH000000324070OtherANTHEM
OH157021763OtherMEDICAID ASSISTANT LIVING WAIVER
OH2438124Medicaid
OH000000324070OtherANTHEM
OH365822Medicare Oscar/Certification