MEDICARE: WINDSOR HOUSE SENIOR LIVING LLC

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1134770308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINDSOR HOUSE SENIOR LIVING LLC

Provider Business Mailing Address
First Line	:	14803 HOLLAND RD
Second Line	:
City	:	BROOKPARK
State	:	OH
Zip	:	44142-3065
Country	:	US
Telephone Number	:	216-302-2719
Fax Number	:	216-803-1999

Provider Business Practice Location Address
First Line	:	14801 HOLLAND RD
Second Line	:
City	:	BROOKPARK
State	:	OH
Zip	:	44142-3092
Country	:	US
Telephone Number	:	216-302-2719
Fax Number	:	216-803-1999

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	MR. JOHN COURY JR.
Credential	:
Telephone Number	:	216-302-2719

Provider Enumeration Date	:	09/27/2019
Last Update Date	:	02/23/2023

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