Provider Demographics
NPI:1275056491
Name:ALS MOUNT VERNON LLC
Entity Type:Organization
Organization Name:ALS MOUNT VERNON LLC
Other - Org Name:MOUNT VERNON HEALTH AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGYANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-620-7828
Mailing Address - Street 1:3546 DUNFEE RD
Mailing Address - Street 2:
Mailing Address - City:COOLVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45723-9722
Mailing Address - Country:US
Mailing Address - Phone:330-350-0379
Mailing Address - Fax:
Practice Address - Street 1:1135 GAMBIER RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-3839
Practice Address - Country:US
Practice Address - Phone:740-392-1099
Practice Address - Fax:740-392-2412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2630N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility