Organization
OAK GROVE MANOR OPERATING COMPANY LLC
Active
Other names
Oak Grove Manor
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY DEGYANSKY LNHA (VICE PRESIDENT OF OPERATIONS)
(330) 620-7828
Entity
Organization
Contact information
Practice address
1670 CRIDER RD, MANSFIELD, OH 44903-9268
(419) 589-6222
Mailing address
5915 LANDERBROOK DR STE 350, MAYFIELD HEIGHTS, OH 44124-4063
(330) 620-7828
(216) 428-2055
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1783N
LICENSURE
OH
Enumeration date
06/22/2020
Last updated
12/17/2024
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