Provider Demographics
NPI:1407584998
Name:PARK VILLAGE ASSISTED LIVING OPERATIONS LLC
Entity Type:Organization
Organization Name:PARK VILLAGE ASSISTED LIVING OPERATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:H
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-447-3490
Mailing Address - Street 1:1525 N CRATER AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-9500
Mailing Address - Country:US
Mailing Address - Phone:330-447-3490
Mailing Address - Fax:
Practice Address - Street 1:1525 N CRATER AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-9500
Practice Address - Country:US
Practice Address - Phone:330-447-3490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility