Organization
EDJ LLC
Active
Other names
BRIARFIELD MANOR
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANE J REESE (MEMBER/ADMINASTRATOR)
(330) 270-3468
Entity
Organization
Contact information
Practice address
461 S CANFIELD NILES RD, YOUNGSTOWN, OH 44515-4022
(330) 270-3468
Mailing address
461 S CANFIELD NILES RD, YOUNGSTOWN, OH 44515-4022
(330) 270-3468
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
0607R
OH
314000000X
Skilled Nursing Facility
Primary
0607N
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000324070
ANTHEM
OH
01
—
157021763
MEDICAID ASSISTANT LIVING WAIVER
OH
05
—
2438124
—
OH
Enumeration date
09/30/2005
Last updated
09/21/2020
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