MEDICARE: 840 SHERMAN HEALTHCARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104005016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	840 SHERMAN HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	25000 COUNTRY CLUB BLVD
Second Line	:	SUITE 255
City	:	NORTH OLMSTED
State	:	OH
Zip	:	44070-5344
Country	:	US
Telephone Number	:	440-614-0160
Fax Number	:	440-614-0168

Provider Business Practice Location Address
First Line	:	840 SHERMAN ST
Second Line	:
City	:	GENEVA
State	:	OH
Zip	:	44041-9101
Country	:	US
Telephone Number	:	440-614-0160
Fax Number	:	440-614-0168

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRIAN COLLERAN
Credential	:
Telephone Number	:	440-614-0160

Provider Enumeration Date	:	10/26/2007
Last Update Date	:	06/16/2014

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