Provider Demographics
NPI:1891747036
Name:TRILOGY HEALTHCARE OF PUTNAM II, LLC
Entity Type:Organization
Organization Name:TRILOGY HEALTHCARE OF PUTNAM II, LLC
Other - Org Name:THE MEADOWS OF OTTAWA-GLANDORF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:P
Authorized Official - Last Name:PLEVYAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-213-1710
Mailing Address - Street 1:575 OTTAWA GLANDORF RD
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:OH
Mailing Address - Zip Code:45875-9426
Mailing Address - Country:US
Mailing Address - Phone:419-538-6529
Mailing Address - Fax:419-538-6520
Practice Address - Street 1:575 OTTAWA GLANDORF RD
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:OH
Practice Address - Zip Code:45875-9426
Practice Address - Country:US
Practice Address - Phone:419-538-6529
Practice Address - Fax:419-538-6520
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRILOGY HEALTH SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-16
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1663N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2613872Medicaid
OH2613872Medicaid