Healthcare Provider Details

I. General information

NPI: 1538245790
Provider Name (Legal Business Name): 60 GENEVA HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 WEST ST
GENEVA OH
44041-9723
US

IV. Provider business mailing address

22021 BROOKPARK RD STE 123
FAIRVIEW PARK OH
44126-3100
US

V. Phone/Fax

Practice location:
  • Phone: 440-466-1181
  • Fax: 440-466-9165
Mailing address:
  • Phone: 440-614-0160
  • Fax: 440-614-0168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1659
License Number StateOH

VIII. Authorized Official

Name: BRIAN COLLERAN
Title or Position: PRESIDENT
Credential:
Phone: 440-614-0160