Provider Demographics
NPI:1114399987
Name:IRONWOOD ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:IRONWOOD ASSISTED LIVING LLC
Other - Org Name:THE INN AT IRONWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
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:330-726-5790
Mailing Address - Street 1:6699 IRONWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-8514
Mailing Address - Country:US
Mailing Address - Phone:330-533-6733
Mailing Address - Fax:330-533-6744
Practice Address - Street 1:6699 IRONWOOD BLVD
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-8514
Practice Address - Country:US
Practice Address - Phone:330-533-6733
Practice Address - Fax:330-533-6744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2611R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0109291Medicaid