Provider Demographics
NPI:1376641068
Name:EDWIN SHAW REHAB, LLC
Entity Type:Organization
Organization Name:EDWIN SHAW REHAB, LLC
Other - Org Name:EDWIN SHAW REHABILITATION INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOC VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BLINCO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:330-436-0931
Mailing Address - Street 1:330 BROADWAY STREET EAST
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221
Mailing Address - Country:US
Mailing Address - Phone:330-436-0910
Mailing Address - Fax:
Practice Address - Street 1:330 BROADWAY STREET EAST
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221
Practice Address - Country:US
Practice Address - Phone:330-436-0910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AKRON GENERAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2600751Medicaid
OH100098OtherQUALCHOICE
OH2600751OtherBCMH
OH000000360936OtherANTHEM BLUE CROSS
OH36T241Medicare Oscar/Certification
OH36T241Medicare Oscar/Certification
OH2600751Medicaid