Provider Demographics
NPI:1114070711
Name:VRABLE IV INC.
Entity Type:Organization
Organization Name:VRABLE IV INC.
Other - Org Name:PEMBROOKE PLACE NURSING AND REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:MERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-545-5500
Mailing Address - Street 1:3248 HENDERSON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-7337
Mailing Address - Country:US
Mailing Address - Phone:614-545-5500
Mailing Address - Fax:
Practice Address - Street 1:850 E MIDLOTHIAN BLVD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502-2507
Practice Address - Country:US
Practice Address - Phone:330-788-3038
Practice Address - Fax:330-788-1806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4293314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2711033Medicaid
OH2711033Medicaid