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NPI Code Detail

MEDICARE: CRESTMONT NURSING HOME NORTH CORP

MEDICARE: CRESTMONT NURSING HOME NORTH CORP
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
1291U00000XClinical Medical Laboratory36D0929858OH

General Provider Information

NPI Number : 1831350610
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRESTMONT NURSING HOME NORTH CORP
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 : 13330 DETROIT AVE
Second Line :
City : LAKEWOOD
State : OH
Zip : 44107-2850
Country : US
Telephone Number : 216-228-9550
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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Directions to “CRESTMONT NURSING HOME NORTH CORP ” Practice Location

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