Healthcare Provider Details

I. General information

NPI: 1750544813
Provider Name (Legal Business Name): OLMSTED MANOR SKILLED NURSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27500 MILL RD
NORTH OLMSTED OH
44070-3115
US

IV. Provider business mailing address

27500 MILL RD
NORTH OLMSTED OH
44070-3115
US

V. Phone/Fax

Practice location:
  • Phone: 440-777-8444
  • Fax:
Mailing address:
  • Phone: 440-777-8444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number36D0908934
License Number StateOH

VIII. Authorized Official

Name: BOB NEMETZ
Title or Position: CONTROLLER
Credential:
Phone: 440-250-4080