Provider Demographics
NPI:1194771543
Name:KENDAL AT OBERLIN
Entity type:Organization
Organization Name:KENDAL AT OBERLIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF HEALTH SERVICES OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:S
Authorized Official - Last Name:TERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:440-775-0094
Mailing Address - Street 1:600 KENDAL DR
Mailing Address - Street 2:
Mailing Address - City:OBERLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44074-1900
Mailing Address - Country:US
Mailing Address - Phone:440-775-0094
Mailing Address - Fax:440-775-9820
Practice Address - Street 1:600 KENDAL DR
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074-1900
Practice Address - Country:US
Practice Address - Phone:440-775-0094
Practice Address - Fax:440-775-9820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4769314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH365956Medicare ID - Type Unspecified