Provider Demographics
NPI:1346846664
Name:THE VILLAGE OF ST. EDWARD AT GREEN
Entity Type:Organization
Organization Name:THE VILLAGE OF ST. EDWARD AT GREEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS/ COO
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MAUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:234-466-5210
Mailing Address - Street 1:3131 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-2613
Mailing Address - Country:US
Mailing Address - Phone:234-466-5210
Mailing Address - Fax:
Practice Address - Street 1:3813 FORTUNA DR
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-5476
Practice Address - Country:US
Practice Address - Phone:234-294-0010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-10
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility