Healthcare Provider Details

I. General information

NPI: 1083690135
Provider Name (Legal Business Name): EAST PARK RETIREMENT COMMUNITY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 07/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 E PARK CIR
BROOKPARK OH
44142-3800
US

IV. Provider business mailing address

8 E PARK CIR
BROOKPARK OH
44142-3800
US

V. Phone/Fax

Practice location:
  • Phone: 216-267-7067
  • Fax: 216-267-5022
Mailing address:
  • Phone: 216-267-7067
  • Fax: 216-267-5022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number365731
License Number StateOH

VIII. Authorized Official

Name: MRS. EILEEN KILBANE
Title or Position: ASSISTANT DIRECTOR OF OPERATIONS
Credential:
Phone: 440-250-4080