Provider Demographics
NPI:1891242251
Name:YOUNGSTOWN BG OPCO LLC
Entity Type:Organization
Organization Name:YOUNGSTOWN BG OPCO LLC
Other - Org Name:CANFIELD PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED SIGNATORY
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:TARSNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-725-7102
Mailing Address - Street 1:330 N WABASH AVE
Mailing Address - Street 2:SUITE 3700
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3586
Mailing Address - Country:US
Mailing Address - Phone:312-725-7000
Mailing Address - Fax:
Practice Address - Street 1:2300 CANFIELD RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44511-2980
Practice Address - Country:US
Practice Address - Phone:844-397-3234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-02
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility