PV SNF LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

PV SNF LLC

Practice address

705 Fulton St
Sidney, OH 45365-3203

Phone

(937) 492-9591

Fax

(937) 498-0529

NPI assigned

Jul 16, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bruce E Wertheim

Title

Manager

Phone

(917) 919-7204

Specialties & licenses 1

Addresses

Other names 1

• The Pavilion Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1437004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437004800000",
    "number": "1114301371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 FULTON ST",
            "city": "SIDNEY",
            "state": "OH",
            "postal_code": "453653203",
            "telephone_number": "937-492-9591",
            "fax_number": "937-498-0529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 FULTON ST",
            "city": "SIDNEY",
            "state": "OH",
            "postal_code": "453653203",
            "telephone_number": "937-492-9591",
            "fax_number": "937-498-0529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PV SNF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-16",
        "last_updated": "2015-07-16",
        "status": "A",
        "authorized_official_last_name": "WERTHEIM",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "917-919-7204"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Pavilion",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Sidney, OH
• Providers in Sidney, OH by specialty
• Skilled Nursing Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.