Provider Demographics
NPI:1689769846
Name:SHEPHERD OF THE VALLEY LUTHERAN RETIREMENT SERVICES, INC.
Entity Type:Organization
Organization Name:SHEPHERD OF THE VALLEY LUTHERAN RETIREMENT SERVICES, INC.
Other - Org Name:SHEPHERD OF THE VALLEY - HOWLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE DIRECTOR/CFO
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:N
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-530-4038
Mailing Address - Street 1:5525 SILICA RD
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-1002
Mailing Address - Country:US
Mailing Address - Phone:330-530-4038
Mailing Address - Fax:330-530-4039
Practice Address - Street 1:4100 N RIVER RD NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-1041
Practice Address - Country:US
Practice Address - Phone:330-856-9232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6329314000000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2366103Medicaid
0293960003Medicare NSC
OH2366103Medicaid