Provider Demographics
NPI:1366266454
Name:SAYBROOK ASSISTED LIVING LLC
Entity type:Organization
Organization Name:SAYBROOK ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:RUPEKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-726-5790
Mailing Address - Street 1:1419 BOARDMAN-CANFIELD ROAD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-8071
Mailing Address - Country:US
Mailing Address - Phone:330-726-5790
Mailing Address - Fax:330-726-5792
Practice Address - Street 1:43171 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:OH
Practice Address - Zip Code:44408-9394
Practice Address - Country:US
Practice Address - Phone:330-892-3200
Practice Address - Fax:330-892-3299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2998ROtherOHIO DEPARTMENT OF HEALTH