Provider Demographics
NPI:1386067429
Name:SKILLED HEALTHCARE, LLC
Entity type:Organization
Organization Name:SKILLED HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SILLAH
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:614-598-5636
Mailing Address - Street 1:1425 E DUBLIN GRANVILLE RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3325
Mailing Address - Country:US
Mailing Address - Phone:614-478-1700
Mailing Address - Fax:614-478-1707
Practice Address - Street 1:1425 E DUBLIN GRANVILLE RD
Practice Address - Street 2:SUITE 109
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3325
Practice Address - Country:US
Practice Address - Phone:614-478-1700
Practice Address - Fax:614-478-1707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-25
Last Update Date:2014-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2262646251E00000X, 251J00000X, 251T00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No253Z00000XAgenciesIn Home Supportive Care