Healthcare Provider Details

I. General information

NPI: 1659821650
Provider Name (Legal Business Name): KIRTLAND LEASING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9865 CHILLICOTHE RD
KIRTLAND OH
44094-9711
US

IV. Provider business mailing address

29225 CHAGRIN BLVD STE 230
CLEVELAND OH
44122-4632
US

V. Phone/Fax

Practice location:
  • Phone: 440-256-8100
  • Fax:
Mailing address:
  • Phone: 440-658-1040
  • Fax: 866-629-9730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1536N
License Number StateOH

VIII. Authorized Official

Name: ELI M GUNZBURG
Title or Position: MANAGER
Credential:
Phone: 216-367-1214