Otterbein North Shore Retirement Community

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

2057R Issued in OH

Legal business name

OTTERBEIN NORTH SHORE RETIREMENT COMMUNITY

Practice address

9400 N Shore Blvd
Lakeside Marblehead, OH 43440-1337

Phone

(419) 798-8203

Fax

(419) 798-4662

NPI assigned

Dec 4, 2008

Last updated

Dec 4, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Rhonda A Nagel, LNHA

Title

Executive Director

Phone

(419) 798-8203

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

North Shore Retirement Community3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• North Shore Retirement Community

  • Assisted Living Facility
  • Lakeside, OH
  • NPI 1588227995
  NPD tax ID
• North Shore Retirement Community

  dba Otterbein North Shore Retirement Living Community

  • Skilled Nursing Facility
  • Lakeside, OH
  • NPI 1760605000
  NPD tax ID

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

{
    "created_epoch": "1228348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228348800000",
    "number": "1619112711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9400 N SHORE BLVD",
            "city": "LAKESIDE MARBLEHEAD",
            "state": "OH",
            "postal_code": "434401337",
            "telephone_number": "419-798-8203",
            "fax_number": "419-798-4662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9400 N SHORE BLVD",
            "city": "LAKESIDE MARBLEHEAD",
            "state": "OH",
            "postal_code": "434401337",
            "telephone_number": "419-798-8203",
            "fax_number": "419-798-4662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OTTERBEIN NORTH SHORE RETIREMENT COMMUNITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-04",
        "last_updated": "2008-12-04",
        "status": "A",
        "authorized_official_last_name": "NAGEL",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "419-798-8203",
        "authorized_official_credential": "LNHA"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "OH",
            "license": "2057R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2856913",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gary Wayne Brown, COTA/L
• McKenzie Browning, PTA
• Danbury Local School District
• Donna Todd Edwards
• Martha Mielke
• Kelly Lynn Walton, PT

• Assisted Living Facility in Lakeside Marblehead, OH
• Providers in Lakeside Marblehead, OH by specialty
• Assisted Living Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2008; 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.