MEDICARE: EMBASSY MADISON MANAGEMENT, 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	314000000X	Skilled Nursing Facility	6263	OH

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	:	1487981536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMBASSY MADISON MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	24579 BROADWAY AVE
Second Line	:
City	:	OAKWOOD VILLAGE
State	:	OH
Zip	:	44146-6338
Country	:	US
Telephone Number	:	440-658-1458
Fax Number	:	440-232-7113

Provider Business Practice Location Address
First Line	:	7600 S RIDGE RD
Second Line	:
City	:	MADISON
State	:	OH
Zip	:	44057-9746
Country	:	US
Telephone Number	:	440-428-1492
Fax Number	:	440-428-8698

Authorized Official
Title or Position	:	ATTORNEY
Name	:	HAYLEY B WILLIAMS
Credential	:
Telephone Number	:	216-706-3864

Provider Enumeration Date	:	11/11/2009
Last Update Date	:	12/08/2009

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