MEDICARE: CENTER RIDGE 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	310400000X	Assisted Living Facility
2	314000000X	Skilled Nursing Facility	4541	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
2	2566R	OTHER	OH	OHIO DEPARTMENT OF HEALTH
3	4541	OTHER	OH	OHIO DEPARTMENT OF HEALTH

General Provider Information

NPI Number	:	1497800866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER RIDGE NURSING HOME, INC.

Provider Business Mailing Address
First Line	:	38642 CENTER RIDGE RD
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-5812
Country	:	US
Telephone Number	:	440-387-5551
Fax Number	:	440-327-6172

Provider Business Practice Location Address
First Line	:	38600 CENTER RIDGE RD
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-2837
Country	:	US
Telephone Number	:	440-327-1295
Fax Number	:	440-353-0204

Authorized Official
Title or Position	:	CONTROLLER
Name	:	NANCY A. PARTYKA
Credential	:
Telephone Number	:	440-387-5551

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	08/14/2023

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