Hall of Fame Divine Opco LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

HALL OF FAME DIVINE OPCO LLC

Practice address

2714 13TH St NW
Canton, OH 44708-3121

Phone

(330) 620-7828

NPI assigned

Apr 30, 2025

Organization subpart

No

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

Authorized official

Name

Jeffrey Degyansky

Title

VP of Operations

Phone

(330) 620-7828

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1745971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745971200000",
    "number": "1831987635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5915 LANDERBROOK DR STE 350",
            "city": "MAYFIELD HEIGHTS",
            "state": "OH",
            "postal_code": "441244063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2714 13TH ST NW",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447083121",
            "telephone_number": "330-620-7828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HALL OF FAME DIVINE OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-30",
        "last_updated": "2025-04-30",
        "certification_date": "2025-04-30",
        "status": "A",
        "authorized_official_last_name": "DEGYANSKY",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "330-620-7828"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristen Hale
• Stacia Nicole Hale
• Toya Hale, DODD
• Latisia Renae Haley
• Husban Ahmad Halim, M.D.
• Hall of Fame Residential Services
• Hall of Fame Woman'S Clinic,Inc
• Antonio A Hall
• Chloe Hall
• Ebony C Hall, LPN

• Skilled Nursing Facility in Canton, OH
• Providers in Canton, 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 Apr 30, 2025; 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.