Provider Demographics
NPI:1538146212
Name:IHS ACQUISITION NO 125 INC
Entity Type:Organization
Organization Name:IHS ACQUISITION NO 125 INC
Other - Org Name:MEADOWVIEW HEALTHCARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-513-8738
Mailing Address - Street 1:76 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44273-9308
Mailing Address - Country:US
Mailing Address - Phone:830-869-2015
Mailing Address - Fax:330-769-3790
Practice Address - Street 1:76 HIGH ST
Practice Address - Street 2:
Practice Address - City:SEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44273-9308
Practice Address - Country:US
Practice Address - Phone:830-869-2015
Practice Address - Fax:330-769-3790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-23
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5464314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2570785Medicaid
365565Medicare Oscar/Certification