Provider Demographics
NPI:1588032965
Name:ORRVILLA, INC.
Entity Type:Organization
Organization Name:ORRVILLA, INC.
Other - Org Name:ORRVILLA MAPLE TERRACE
Other - Org Type:Other Name
Authorized Official - Title/Position:RESIDENT SERVICES MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:STROUD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:330-683-4455
Mailing Address - Street 1:333 E SASSAFRAS ST
Mailing Address - Street 2:
Mailing Address - City:ORRVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44667-2250
Mailing Address - Country:US
Mailing Address - Phone:330-683-4455
Mailing Address - Fax:330-683-7375
Practice Address - Street 1:333 E SASSAFRAS ST
Practice Address - Street 2:
Practice Address - City:ORRVILLE
Practice Address - State:OH
Practice Address - Zip Code:44667-2250
Practice Address - Country:US
Practice Address - Phone:330-683-4455
Practice Address - Fax:330-683-7375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2408R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility