Healthcare Provider Details

I. General information

NPI: 1902318959
Provider Name (Legal Business Name): HILLSTONE EJ RA HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2017
Last Update Date: 10/31/2017
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

544 ENTERPRISE DR STE G
LEWIS CENTER OH
43035-9704
US

V. Phone/Fax

Practice location:
  • Phone: 216-267-5445
  • Fax: 216-267-5936
Mailing address:
  • Phone: 937-825-6622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0993N
License Number StateOH

VIII. Authorized Official

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