Provider Demographics
NPI:1275758666
Name:DANRIDGE NURSING HOME INC
Entity Type:Organization
Organization Name:DANRIDGE NURSING HOME INC
Other - Org Name:DANRIDGES BURGUNDI MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JO ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-746-5157
Mailing Address - Street 1:31 MARANATHA CT
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505
Mailing Address - Country:US
Mailing Address - Phone:330-746-5157
Mailing Address - Fax:330-746-2508
Practice Address - Street 1:31 MARANATHA CT
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-4970
Practice Address - Country:US
Practice Address - Phone:330-746-5157
Practice Address - Fax:330-746-2508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2232NH314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0364950001Medicare NSC