MEDICARE: RANDALL RESIDENCE AT ROYALTON WOODS

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		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	:	1538616503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANDALL RESIDENCE AT ROYALTON WOODS

Provider Business Mailing Address
First Line	:	14277 STATE RD
Second Line	:
City	:	NORTH ROYALTON
State	:	OH
Zip	:	44133-5130
Country	:	US
Telephone Number	:	440-582-4111
Fax Number	:	440-237-1226

Provider Business Practice Location Address
First Line	:	14277 STATE RD
Second Line	:
City	:	NORTH ROYALTON
State	:	OH
Zip	:	44133-5130
Country	:	US
Telephone Number	:	440-582-4111
Fax Number	:	440-237-1226

Authorized Official
Title or Position	:	CEO
Name	:	MR. CHRISTOPHER RANDALL
Credential	:
Telephone Number	:	269-624-4841

Provider Enumeration Date	:	09/07/2016
Last Update Date	:	09/07/2016

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