NPIMap

Organization Active NPI

Hollowood House

  • Intellectual Disabilities Intermediate Care Facility
  • Brunswick, OH
National Provider Identifier
1225045255
Registry record updated Jul 12, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
5210284 Issued in OH
Legal business name
HOLLOWOOD HOUSE
Practice address
3717 Alesia Kae Dr
Brunswick, OH 44212-5012
Phone
(330) 273-5494
Fax
(330) 273-6199
NPI assigned
Aug 2, 2006
Last updated
Jul 12, 2007By the provider in NPPES
Organization subpart
Yes
Parent organization
TRANSITIONAL LIVING CENTERS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 12, 2007

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

Authorized official

Name
Denise T Pozderac, LNHA
Title
President/Administrator
Phone
(330) 273-5494

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 5210284 OH Primary

Addresses

Primary practice location

3717 Alesia Kae Dr
Brunswick, OH 44212-5012

Mailing address

791 Pearl Rd
Brunswick, OH 44212-2528
Phone (330) 273-5494

Other identifiers 2

IdentifierTypeStateIssuer
2015161MedicaidOH
36-G533MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225045255. Details of each certification follow.

  • CCN 36G533 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 36G533

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
HOLLOWOOD HOUSE
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Aug 7, 1997
Last certification
Jul 18, 2024
Beds
8
Ownership / control type
Private (proprietary)
Facility address
3717 Alesia Kae Road
Brunswick, OH 44212

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D0930435Hollowood House3717 Alesia Kae Drive, Brunswick, OH 44212Certificate of waiverJul 14, 2027

National Provider Directory

National Provider Directory
Tax ID family
Valley House14 organizations share this tax ID, including this one
Part of
Valley House

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184198400000",
    "number": "1225045255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "791 PEARL RD",
            "city": "BRUNSWICK",
            "state": "OH",
            "postal_code": "442122528",
            "telephone_number": "330-273-5494",
            "fax_number": "330-273-6199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3717 ALESIA KAE DR",
            "city": "BRUNSWICK",
            "state": "OH",
            "postal_code": "442125012",
            "telephone_number": "330-273-5494",
            "fax_number": "330-273-6199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLLOWOOD HOUSE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TRANSITIONAL LIVING CENTERS, INC.",
        "enumeration_date": "2006-08-02",
        "last_updated": "2007-07-12",
        "status": "A",
        "authorized_official_last_name": "POZDERAC",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT/ADMINISTRATOR",
        "authorized_official_telephone_number": "330-273-5494",
        "authorized_official_credential": "LNHA"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "OH",
            "license": "5210284",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2015161",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36-G533",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brunswick, OH

Sources for this page

Verify at the official NPI Registry.