Provider Demographics
NPI:1962459024
Name:MEDINA VILLAGE RETIREMENT COMMUNITY, LTD
Entity Type:Organization
Organization Name:MEDINA VILLAGE RETIREMENT COMMUNITY, LTD
Other - Org Name:MEDINA VILLAGE SKILLED NURSING AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES., VRC, INC MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FRANCUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-929-0009
Mailing Address - Street 1:555 SPRINGBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3651
Mailing Address - Country:US
Mailing Address - Phone:330-725-3398
Mailing Address - Fax:330-350-5144
Practice Address - Street 1:555 SPRINGBROOK DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3651
Practice Address - Country:US
Practice Address - Phone:330-725-3393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2601312Medicaid
OH365667Medicare ID - Type Unspecified
OH=========OtherINSURANACE COMPANIES