Provider Demographics
NPI:1659885135
Name:NIVALIS HEALTH LLC
Entity Type:Organization
Organization Name:NIVALIS HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:REZNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-571-2925
Mailing Address - Street 1:915 BASSETT ROAD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1108
Mailing Address - Country:US
Mailing Address - Phone:440-462-2600
Mailing Address - Fax:440-250-8670
Practice Address - Street 1:915 BASSETT ROAD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1108
Practice Address - Country:US
Practice Address - Phone:440-462-2600
Practice Address - Fax:440-250-8670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-20
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0248HSP251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0331674Medicaid
OH0248HSPOtherDO NOT HAVE A MEDICARE OR MEDICAID NUMBER YET.