Healthcare Provider Details

I. General information

NPI: 1053904151
Provider Name (Legal Business Name): EMBASSY VALLEY VIEW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2021
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3363 RAGGED RIDGE RD
FRANKFORT OH
45628-9551
US

IV. Provider business mailing address

25201 CHAGRIN BLVD STE 190
BEACHWOOD OH
44122-5633
US

V. Phone/Fax

Practice location:
  • Phone: 740-998-2948
  • Fax:
Mailing address:
  • Phone: 216-378-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: GEORGE REPCHICK
Title or Position: MANAGER
Credential:
Phone: 216-378-2050