Provider Demographics
NPI:1255548392
Name:LIFE CARE CENTER OF MEDINA
Entity type:Organization
Organization Name:LIFE CARE CENTER OF MEDINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REHAB
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:EBERHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-483-3131
Mailing Address - Street 1:5839 SLEEPY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY CITY
Mailing Address - State:OH
Mailing Address - Zip Code:44280-9738
Mailing Address - Country:US
Mailing Address - Phone:330-483-3305
Mailing Address - Fax:
Practice Address - Street 1:2400 COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-9414
Practice Address - Country:US
Practice Address - Phone:330-483-3131
Practice Address - Fax:330-483-3132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH007861314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility