Provider Demographics
NPI:1619963980
Name:EAST LIVERPOOL CONVALESCENT CENTER, INC
Entity Type:Organization
Organization Name:EAST LIVERPOOL CONVALESCENT CENTER, INC
Other - Org Name:ADKINS 2
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOWDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:330-385-3600
Mailing Address - Street 1:701 ARMSTRONG LN
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-1284
Mailing Address - Country:US
Mailing Address - Phone:330-385-5212
Mailing Address - Fax:330-385-8566
Practice Address - Street 1:701 ARMSTRONG LN
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-1284
Practice Address - Country:US
Practice Address - Phone:330-385-5212
Practice Address - Fax:330-385-8566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1542314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0272682Medicaid
OH0272682Medicaid