Provider Demographics
NPI:1164248209
Name:CEDARVALE COMMONS REHABILITATION AND HEALTHCARE CENTER LLC
Entity type:Organization
Organization Name:CEDARVALE COMMONS REHABILITATION AND HEALTHCARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUBENMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-335-9270
Mailing Address - Street 1:375 S GLENN AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-1713
Mailing Address - Country:US
Mailing Address - Phone:740-335-9270
Mailing Address - Fax:
Practice Address - Street 1:375 S GLENN AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-1713
Practice Address - Country:US
Practice Address - Phone:740-335-9270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-22
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility