Provider Demographics
NPI:1407843931
Name:LISBON SKILLED NURSING AND RESIDENTIAL CARE, LLC
Entity Type:Organization
Organization Name:LISBON SKILLED NURSING AND RESIDENTIAL CARE, LLC
Other - Org Name:CONTINUING HEALTHCARE OF LISBON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARSONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-772-1105
Mailing Address - Street 1:2875 CENTER RD STE 6
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-2319
Mailing Address - Country:US
Mailing Address - Phone:216-772-1105
Mailing Address - Fax:
Practice Address - Street 1:100 VISTA DR
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-1008
Practice Address - Country:US
Practice Address - Phone:330-424-5852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2090R310400000X
OH2090N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH155884375OtherMEDICAID ASSISTED LIVING WAIVER
OH000000321362OtherANTHEM
OH2434646Medicaid
OH200322973OtherEIN #
OH366087Medicare Oscar/Certification
OH4997670001Medicare NSC