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NPI Code Detail

MEDICARE: WESTLAKE OH REALTY LLC

MEDICARE: WESTLAKE OH REALTY 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
1314000000XSkilled Nursing FacilityOH

General Provider Information

NPI Number : 1891212106
Entity Type Code : Organization
Provider Name (Legal Business Name) : WESTLAKE OH REALTY LLC
Provider Business Mailing Address
First Line : 180 SYLVAN AVE STE 2
Second Line :
City : ENGLEWOOD CLIFFS
State : NJ
Zip : 07632-2519
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4650 ROCKY RIVER DR
Second Line :
City : CLEVELAND
State : OH
Zip : 44135-3846
Country : US
Telephone Number : 201-731-1700
Fax Number : 201-731-1700
Authorized Official
Title or Position : CEO
Name : MARK FRIEDMAN
Credential :
Telephone Number : 201-731-1700
Provider Enumeration Date : 08/28/2017
Last Update Date : 08/28/2017

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Directions to “WESTLAKE OH REALTY LLC ” Practice Location

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