MEDICARE: MERRIMAN CCRC, 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	0523R	OH

General Provider Information

NPI Number	:	1801032230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERRIMAN CCRC, INC.

Provider Business Mailing Address
First Line	:	25000 COUNTRY CLUB BLVD
Second Line	:	STE 255
City	:	NORTH OLMSTED
State	:	OH
Zip	:	44070-5344
Country	:	US
Telephone Number	:	440-614-0160
Fax Number	:	440-614-0168

Provider Business Practice Location Address
First Line	:	209 MERRIMAN RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44303-1904
Country	:	US
Telephone Number	:	330-762-9341
Fax Number	:	330-762-0450

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRIAN COLLERAN
Credential	:
Telephone Number	:	440-614-0160

Provider Enumeration Date	:	01/07/2009
Last Update Date	:	03/24/2015

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