Healthcare Provider Details

I. General information

NPI: 1427437698
Provider Name (Legal Business Name): 17322 EUCLID AVENUE COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17322 EUCLID AVE
CLEVELAND OH
44112-1210
US

IV. Provider business mailing address

17322 EUCLID AVE
CLEVELAND OH
44112-1210
US

V. Phone/Fax

Practice location:
  • Phone: 216-486-2280
  • Fax: 216-383-4307
Mailing address:
  • Phone: 216-486-2280
  • Fax: 216-383-4307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0318N
License Number StateOH

VIII. Authorized Official

Name: HAYLEY B WILLIAMS
Title or Position: ATTORNEY
Credential:
Phone: 216-706-3936