Provider Demographics
NPI:1780903765
Name:GALION POINTE LLC
Entity type:Organization
Organization Name:GALION POINTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:COOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-476-8018
Mailing Address - Street 1:925 WAGNER AVE
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-1535
Mailing Address - Country:US
Mailing Address - Phone:419-468-1090
Mailing Address - Fax:
Practice Address - Street 1:925 WAGNER AVE
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-1535
Practice Address - Country:US
Practice Address - Phone:419-468-1090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-29
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1673N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH365385Medicare PIN