Healthcare Provider Details

I. General information

NPI: 1700370640
Provider Name (Legal Business Name): 3660 GREENTREE LEASING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 GREENTREE AVE SW
CANTON OH
44706-4024
US

IV. Provider business mailing address

29225 CHAGRIN BLVD STE 230
CLEVELAND OH
44122-4632
US

V. Phone/Fax

Practice location:
  • Phone: 330-484-5888
  • Fax: 330-484-5246
Mailing address:
  • Phone: 216-367-1214
  • Fax: 866-629-9730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2758N
License Number StateOH

VIII. Authorized Official

Name: ELI M. GUNZBURG
Title or Position: MANAGER
Credential:
Phone: 216-367-1214