Healthcare Provider Details

I. General information

NPI: 1538159256
Provider Name (Legal Business Name): RAE-ANN CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 ROCKY RIVER DR
CLEVELAND OH
44135-3846
US

IV. Provider business mailing address

PO BOX 40175
BAY VILLAGE OH
44140-0175
US

V. Phone/Fax

Practice location:
  • Phone: 216-267-5445
  • Fax:
Mailing address:
  • Phone: 440-835-3005
  • Fax: 440-871-3776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5150
License Number StateOH

VIII. Authorized Official

Name: MR. JOHN S. GRIFFITHS
Title or Position: VICE PRESIDENT
Credential: LNHA
Phone: 440-835-3005