MEDICARE: MYOCARE NURSING HOME 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	291U00000X	Clinical Medical Laboratory	36D0912921	OH

General Provider Information

NPI Number	:	1225299019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYOCARE NURSING HOME INC

Provider Business Mailing Address
First Line	:	24340 SPERRY DR
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-1565
Country	:	US
Telephone Number	:	440-617-2103
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 W 150TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-1311
Country	:	US
Telephone Number	:	216-252-7555
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY TREASURER
Name	:	MR. NORMAN A FOX JR.
Credential	:
Telephone Number	:	440-617-2103

Provider Enumeration Date	:	06/24/2008
Last Update Date	:	06/24/2008

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