Provider Demographics
NPI:1124268222
Name:THE DEROL COMPANY LLC
Entity type:Organization
Organization Name:THE DEROL COMPANY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:DIANA
Authorized Official - Last Name:GROSH
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:440-235-7590
Mailing Address - Street 1:25920 ELM ST
Mailing Address - Street 2:
Mailing Address - City:OLMSTED FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44138-1616
Mailing Address - Country:US
Mailing Address - Phone:440-235-7590
Mailing Address - Fax:
Practice Address - Street 1:25920 ELM ST
Practice Address - Street 2:
Practice Address - City:OLMSTED FALLS
Practice Address - State:OH
Practice Address - Zip Code:44138-1616
Practice Address - Country:US
Practice Address - Phone:440-235-7590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2331R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2866297Medicaid