Provider Demographics
NPI:1457338360
Name:PROVIDE A CARE INC
Entity Type:Organization
Organization Name:PROVIDE A CARE INC
Other - Org Name:SHADY LAWN NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROB
Authorized Official - Middle Name:T
Authorized Official - Last Name:ANESHANSEL
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:330-828-2278
Mailing Address - Street 1:15028 OLD LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44618-9731
Mailing Address - Country:US
Mailing Address - Phone:330-828-2278
Mailing Address - Fax:330-828-2041
Practice Address - Street 1:15028 OLD LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:OH
Practice Address - Zip Code:44618-9731
Practice Address - Country:US
Practice Address - Phone:330-828-2278
Practice Address - Fax:330-828-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2307314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7968472Medicaid
OH7968472Medicaid