St. John's Villa

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

1010128 Issued in OH

Legal business name

ST. JOHN'S VILLA

Practice address

701 Crest St NW
Carrollton, OH 44615-8425

Phone

(330) 627-9789

Fax

(330) 627-4826

NPI assigned

Dec 1, 2006

Organization subpart

No

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

Authorized official

Name

David L. Lyon

Title

President

Phone

(330) 627-9789

Specialties & licenses 1

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213574400000",
    "number": "1174691927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 CREST ST NW",
            "address_2": "PO BOX 457",
            "city": "CARROLLTON",
            "state": "OH",
            "postal_code": "446158425",
            "telephone_number": "330-627-9789",
            "fax_number": "330-627-4826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 CREST ST NW",
            "city": "CARROLLTON",
            "state": "OH",
            "postal_code": "446158425",
            "telephone_number": "330-627-9789",
            "fax_number": "330-627-4826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOHN'S VILLA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2008-06-16",
        "status": "A",
        "authorized_official_last_name": "LYON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "330-627-9789"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "OH",
            "license": "1010128",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MRDD PROVIDER",
            "identifier": "M1000179",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patrick Jon Snyder, MPT
• Southeast Inc (Southeast Healthcare)
• Kate Elizabeth Spahlinger, LPCC
• Trisha Spencer
• Amy Nichole Spicer
• Connie Stanik, M.A., CCC-SLP
• Stephen C. Dowell DDS Inc
• Stephen C. Dowell DDS, Inc.
• Walter Scott Stine, M.D.
• Neil R Stoneman, RPH

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Carrollton, OH
• Providers in Carrollton, OH by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.