Healthcare Provider Details

I. General information

NPI: 1538239314
Provider Name (Legal Business Name): MONTEFIORE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE DAVID N MYERS PARKWAY
BEACHWOOD OH
44122
US

IV. Provider business mailing address

ONE DAVID N MYERS PARKWAY
BEACHWOOD OH
44122-1162
US

V. Phone/Fax

Practice location:
  • Phone: 216-910-2641
  • Fax: 216-910-2299
Mailing address:
  • Phone: 216-910-2641
  • Fax: 216-910-2299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1956N
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number332BN1400X
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number332BP3500X
License Number StateOH

VIII. Authorized Official

Name: MS. LAUREN B ROCK
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 216-360-9080