Provider Demographics
NPI:1477143832
Name:GARDENS AT ST. HENRY OPERATING COMPANY, LLC
Entity type:Organization
Organization Name:GARDENS AT ST. HENRY OPERATING COMPANY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGYANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:330-620-7828
Mailing Address - Street 1:522 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT HENRY
Mailing Address - State:OH
Mailing Address - Zip Code:45883-9777
Mailing Address - Country:US
Mailing Address - Phone:419-678-9800
Mailing Address - Fax:
Practice Address - Street 1:522 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SAINT HENRY
Practice Address - State:OH
Practice Address - Zip Code:45883-9777
Practice Address - Country:US
Practice Address - Phone:419-678-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-20
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2282ROtherLICENSURE