Healthcare Provider Details

I. General information

NPI: 1235115387
Provider Name (Legal Business Name): OLMSTED MANOR, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27500 MILL RD
NORTH OLMSTED OH
44070
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: 440-777-5796
Mailing address:
  • Phone: 440-777-8444
  • Fax: 440-777-5796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number365533
License Number StateOH

VIII. Authorized Official

Name: MICHELLE MROCZKA
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 440-835-1181