Provider Demographics
NPI:1750468872
Name:TRILOGY HEALTHCARE OF HURON,LLC
Entity Type:Organization
Organization Name:TRILOGY HEALTHCARE OF HURON,LLC
Other - Org Name:THE WILLOWS AT WILLARD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PLEVYAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-213-1710
Mailing Address - Street 1:1050 NEAL ZICK ROAD
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:OH
Mailing Address - Zip Code:44890-9287
Mailing Address - Country:US
Mailing Address - Phone:419-935-6511
Mailing Address - Fax:419-933-1630
Practice Address - Street 1:1050 NEAL ZICK ROAD
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-9287
Practice Address - Country:US
Practice Address - Phone:419-935-6511
Practice Address - Fax:419-933-1630
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRILOGY HEALTH SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-01
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1643N314000000X
OH2610N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2568421Medicaid
OH2568421Medicaid