Provider Demographics
NPI:1477539070
Name:NORTHFIELD VILLAGE RETIREMENT COMMUNITY, LTD.
Entity Type:Organization
Organization Name:NORTHFIELD VILLAGE RETIREMENT COMMUNITY, LTD.
Other - Org Name:NORTHFIELD VILLAGE SKILLED NURSING AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES., VRC, INC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRANCUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-929-0009
Mailing Address - Street 1:10267 NORTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44067-1418
Mailing Address - Country:US
Mailing Address - Phone:330-468-1800
Mailing Address - Fax:330-468-2666
Practice Address - Street 1:10267 NORTHFIELD RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44067-1418
Practice Address - Country:US
Practice Address - Phone:330-468-1800
Practice Address - Fax:330-342-4719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2385N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2410886Medicaid
OH2385NOtherNURSING FACILITY
OH2410886Medicaid