Healthcare Provider Details

I. General information

NPI: 1609831429
Provider Name (Legal Business Name): MENORAH PARK CENTER FOR SENIOR LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27100 CEDAR RD
BEACHWOOD OH
44122-1109
US

IV. Provider business mailing address

27100 CEDAR RD
BEACHWOOD OH
44122-1109
US

V. Phone/Fax

Practice location:
  • Phone: 216-831-6500
  • Fax: 216-831-5492
Mailing address:
  • Phone: 216-831-6500
  • Fax: 216-831-5492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5870
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number5870
License Number StateOH

VIII. Authorized Official

Name: JULIANN MINNIE
Title or Position: DIRECTOR REVENUE CYCLE
Credential:
Phone: 216-910-2550