Provider Demographics
NPI:1760473961
Name:STOW-GLEN INC
Entity Type:Organization
Organization Name:STOW-GLEN INC
Other - Org Name:DASHER RETIREMENT VILLAGE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DENTON
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:330-686-7170
Mailing Address - Street 1:4285 KENT RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-4355
Mailing Address - Country:US
Mailing Address - Phone:330-686-7100
Mailing Address - Fax:330-686-7173
Practice Address - Street 1:4285 KENT RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-4355
Practice Address - Country:US
Practice Address - Phone:330-686-7100
Practice Address - Fax:330-686-7173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1797R310400000X
OH1797N313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0580698Medicaid
OH1797NOtherNURSING HOME NUMBER
OH366278Medicare ID - Type UnspecifiedMEDICARE NUMBER