Healthcare Provider Details

I. General information

NPI: 1457855983
Provider Name (Legal Business Name): AJ CITYVIEW NURSING & REHAB OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6606 CARNEGIE AVE
CLEVELAND OH
44103-4622
US

IV. Provider business mailing address

555 ANTHONY WAYNE TRL
WATERVILLE OH
43566-1516
US

V. Phone/Fax

Practice location:
  • Phone: 216-361-1414
  • Fax: 216-361-2822
Mailing address:
  • Phone: 330-720-0406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1814N
License Number StateOH

VIII. Authorized Official

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