Provider Demographics
NPI:1326407339
Name:MEADOW GROVE CITY, INC.
Entity Type:Organization
Organization Name:MEADOW GROVE CITY, INC.
Other - Org Name:MEADOW GROVE TRANSITIONAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-204-1040
Mailing Address - Street 1:782 W ORANGE RD
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-8922
Mailing Address - Country:US
Mailing Address - Phone:330-204-1040
Mailing Address - Fax:
Practice Address - Street 1:5919 BLUE STAR DR
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-7595
Practice Address - Country:US
Practice Address - Phone:330-204-1040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0160229Medicaid
OH366446Medicare Oscar/Certification