PEARL III LEASING CO LLC NPI 1417079021

NPI Information

NPI: 1417079021
Provider Name: PEARL III LEASING CO, LLC

Doing Business As: PINE GROVE HABILITATION CENTER

Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization
Address:
5608 PEARL RD
PARMA, OH
ZIP 44129
Phone: (440) 888-1320
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PEARL III LEASING CO, LLC is an intermediate care facility mentally retarded in Parma, OH. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. PEARL III LEASING CO, LLC NPI is 1417079021. The provider is registered as an organization entity type.
The provider Is Doing Business As Pine Grove Habilitation Center.

The provider's business location address is:

5608 PEARL RD
PARMA, OH
ZIP 44129-547
Phone: (440) 888-1320
Fax: (440) 888-1304

The provider's authorized official is Sandra K Hubbard .
The authorized official title is Dir Of A/r and has the following contact phone number (513) 530-1327.

The enumeration date for this NPI number is 4/4/2007 and was last updated on 12/18/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities		25454	OHIO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	2607129	MEDICAID	OHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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