Provider Demographics
NPI:1235608290
Name:MV SEVILLE SNF LLC
Entity Type:Organization
Organization Name:MV SEVILLE SNF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRENTISS
Authorized Official - Middle Name:E
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:III
Authorized Official - Credentials:AUTHORIZED OFFICIAL
Authorized Official - Phone:251-583-3972
Mailing Address - Street 1:408 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:ATTALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35954-1025
Mailing Address - Country:US
Mailing Address - Phone:251-583-3972
Mailing Address - Fax:330-595-4344
Practice Address - Street 1:83 HIGH ST
Practice Address - Street 2:
Practice Address - City:SEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44273-9308
Practice Address - Country:US
Practice Address - Phone:330-769-2015
Practice Address - Fax:330-769-1847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-20
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility