Provider Demographics
NPI:1275297020
Name:EAST PARK OPERATIONS LLC
Entity Type:Organization
Organization Name:EAST PARK OPERATIONS LLC
Other - Org Name:EAST PARK, THE INN - INDEPENDENT LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGYANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-620-7828
Mailing Address - Street 1:6360 ELMDALE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKPARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-4075
Mailing Address - Country:US
Mailing Address - Phone:330-620-7828
Mailing Address - Fax:
Practice Address - Street 1:6360 ELMDALE RD
Practice Address - Street 2:
Practice Address - City:BROOKPARK
Practice Address - State:OH
Practice Address - Zip Code:44142-4075
Practice Address - Country:US
Practice Address - Phone:330-620-7828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-27
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility