Provider Demographics
NPI:1073127486
Name:MALLARD COVE SENIOR DEVELOPMENT, LLC
Entity Type:Organization
Organization Name:MALLARD COVE SENIOR DEVELOPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-705-9397
Mailing Address - Street 1:1410 MALLARD COVE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3920
Mailing Address - Country:US
Mailing Address - Phone:513-772-6655
Mailing Address - Fax:
Practice Address - Street 1:1410 MALLARD COVE DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3920
Practice Address - Country:US
Practice Address - Phone:513-772-6655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility