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EDJ LLC

Assisted Living Facility

Youngstown, Ohio

Provider NPI: 1053308577

Organization Information:
Organization Name:  EDJ LLC


Practice Location:
461 S CANFIELD NILES RD  YOUNGSTOWN, OH 44515 US
Tel: 330-270-3468  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N310400000XNursing & Custodial Care Facilities
Assisted Living Facility
OH0607R
Y314000000XNursing & Custodial Care Facilities
Skilled Nursing Facility
OH0607N

Other Provider Identifiers:

IssuerNumberStateType
MEDICAID ASSISTANT LIVING WAIVER157021763OH01
2438124OH05
ANTHEM000000324070OH01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin




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