South Avenue Assisted Living, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

SOUTH AVENUE ASSISTED LIVING, LLC

Doing business as

The Inn at Walker Mill

Practice address

8060 South Ave
Boardman, OH 44512-6108

Phone

(330) 726-5790

NPI assigned

May 17, 2018

Organization subpart

No

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

Authorized official

Name

Edward Reese Jr.

Title

Director of Business Development

Phone

(330) 726-5790

Specialties & licenses 1

Addresses

Other names 1

• The Inn at Walker Mill Doing business as

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": "1526515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526515200000",
    "number": "1710477567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1419 BOARDMAN CANFIELD RD STE 500",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445128071",
            "telephone_number": "330-726-5790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8060 SOUTH AVE",
            "city": "BOARDMAN",
            "state": "OH",
            "postal_code": "445126108",
            "telephone_number": "330-726-5790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH AVENUE ASSISTED LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-17",
        "last_updated": "2018-05-17",
        "status": "A",
        "authorized_official_last_name": "REESE",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "DIRECTOR OF BUSINESS DEVELOPMENT",
        "authorized_official_telephone_number": "330-726-5790",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Inn at Walker Mill",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amanda Nichole Snyder, DPT
• Andrea Jill Snyder, PHD
• Carrie Lynn Snyder, M.S., BCBA, COBA
• Phil J Snyder, DDS
• Stephen Snyder
• South I Leasing Co., LLC
• South II Leasing Co., LLC
• South III Leasing Co., LLC
• Southwoods Anesthesia Inc
• Southwoods Counseling LLC

• Assisted Living Facility in Boardman, OH
• Providers in Boardman, 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 May 17, 2018; 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.