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Contact Information

GRAND LAKE OPERATIONS, LLC
1035 HAGER STREET
SAINT MARYS, OH45885
 Phone: 419-394-3308
 Fax: 419-394-3300
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Skilled Nursing Facility

314000000X A1[8] Skilled Nursing Facility
Indicates primary specialty

NPI Profile & details for GRAND LAKE OPERATIONS, LLC

NPI # 1720633639
LBN Legal business name GRAND LAKE OPERATIONS, LLC
Authorized official EDGAR SILALAHI - (CFO)
Entity Organization
Organization subpart 1 No
Enumeration date 08/07/2019
Last updated 05/19/2026 - About 3 weeks ago
Identifiers
OH Medicaid 0363613
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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