Provider Demographics
NPI:1578511077
Name:MINERVA CONVALESCENT CENTER LLC
Entity Type:Organization
Organization Name:MINERVA CONVALESCENT CENTER LLC
Other - Org Name:MINERVA HEALTHCARE AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:EPERESI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-265-1164
Mailing Address - Street 1:8796 ROUTE 219
Mailing Address - Street 2:
Mailing Address - City:BROCKWAY
Mailing Address - State:PA
Mailing Address - Zip Code:15824-6010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1035 EAST LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:MINERVA
Practice Address - State:OH
Practice Address - Zip Code:44657
Practice Address - Country:US
Practice Address - Phone:330-868-4147
Practice Address - Fax:330-868-4148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
PA314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2515399Medicaid
322138OtherBCBS
OH2515399Medicaid
366187Medicare Oscar/Certification