Healthcare Provider Details

I. General information

NPI: 1114578234
Provider Name (Legal Business Name): HOMEWOOD SENIOR LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 HOMEWOOD WAY
CLEVELAND OH
44143-2955
US

IV. Provider business mailing address

2668 NORTHPARK DR
LAFAYETTE CO
80026-3199
US

V. Phone/Fax

Practice location:
  • Phone: 216-291-8585
  • Fax:
Mailing address:
  • Phone: 303-952-9216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: DEAN KIKLIS
Title or Position: MEMBER
Credential:
Phone: 303-952-9216