Provider Demographics
NPI:1164831103
Name:SOUTHWOODS REHABILITATION LLC
Entity Type:Organization
Organization Name:SOUTHWOODS REHABILITATION LLC
Other - Org Name:SOUTHWOODS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MURANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-758-1954
Mailing Address - Street 1:7630 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5633
Mailing Address - Country:US
Mailing Address - Phone:330-729-8001
Mailing Address - Fax:330-729-8029
Practice Address - Street 1:2860 CANFIELD RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44511-2803
Practice Address - Country:US
Practice Address - Phone:330-799-6298
Practice Address - Fax:330-799-4867
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE SURGERY CENTER AT SOUTHWOODS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-04
Last Update Date:2014-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X, 225X00000X, 235Z00000X, 284300000X
OH0046AS261QA1903X
OH1485282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes284300000XHospitalsSpecial Hospital
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH36-0352OtherCMS CERTIFICATION NUMBER
OH2369619Medicaid
OH3610712Medicare PIN