Organization
PEARL LL LEASING CO, LLC
Active
Other names
Pine Grove Habilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBORAH KAY SMITH (DIRECTOR)
(440) 888-1320
Entity
Organization
Contact information
Practice address
5608 PEARL RD, PARMA, OH 44129-2547
(440) 888-1320
(440) 888-1304
Mailing address
5608 PEARL RD, PARMA, OH 44129-2547
(440) 888-1320
(440) 888-1304
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
25454
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2607129
—
OH
Enumeration date
10/06/2006
Last updated
07/21/2022
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