Healthcare Provider Details

I. General information

NPI: 1013541812
Provider Name (Legal Business Name): EMBASSY LEBANON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2020
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MONROE RD
LEBANON OH
45036-1409
US

IV. Provider business mailing address

945 BROADWAY
WOODMERE NY
11598-1733
US

V. Phone/Fax

Practice location:
  • Phone: 513-932-0105
  • Fax:
Mailing address:
  • Phone: 516-869-3700
  • 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: HAYLEY WILLIAMS
Title or Position: ATTORNEY
Credential:
Phone: 216-706-3936