Basic Information
| Provider Information | |||||||||
| NPI: | 1528586831 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUMMIT VILLA CARE CENTER LLC | ||||||||
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| OtherOrganizationName: | THE PINNACLE REHABILITATION AND NURSING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 270 MADISON AVE FL 17 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100160601 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 330 SOUTHWEST AVE | ||||||||
| Address2: | |||||||||
| City: | TALLMADGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442782235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306330555 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2017 | ||||||||
| LastUpdateDate: | 09/07/2017 | ||||||||
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| AuthorizedOfficialLastName: | LAHASKY | ||||||||
| AuthorizedOfficialFirstName: | EPHRAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3306330555 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 0731N | 01 | OH | OHIO DEPARTMENT OF HEALTH HOME NUMBER | OTHER |