MEDICARE: FAIRVIEW VILLAGE RETIREMENT COMMUNITY, LTD

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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1902958267
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAIRVIEW VILLAGE RETIREMENT COMMUNITY, LTD

Provider Business Mailing Address
First Line	:	4110 ROCKY RIVER DR
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-1175
Country	:	US
Telephone Number	:	216-941-6100
Fax Number	:

Provider Business Practice Location Address
First Line	:	4110 ROCKY RIVER DR
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-1175
Country	:	US
Telephone Number	:	216-941-6100
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. JANICE MARIE COLLINS
Credential	:	LNHA
Telephone Number	:	330-920-6555

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	08/22/2020

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Directions to “FAIRVIEW VILLAGE RETIREMENT COMMUNITY, LTD ” Practice Location

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