Provider Demographics
NPI:1295169100
Name:SHEPHERD OF THE VALLEY LUTHERAN RETIREMENT SERVICES, INC.
Entity type:Organization
Organization Name:SHEPHERD OF THE VALLEY LUTHERAN RETIREMENT SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C.F.O.
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-530-4038
Mailing Address - Street 1:5525 SILICA RD
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-1002
Mailing Address - Country:US
Mailing Address - Phone:330-530-4038
Mailing Address - Fax:330-530-4039
Practice Address - Street 1:1501 TIBBETTS WICK RD
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-1206
Practice Address - Country:US
Practice Address - Phone:330-544-0771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-27
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2675494Medicaid