Healthcare Provider Details

I. General information

NPI: 1679122147
Provider Name (Legal Business Name): HOMEWOOD SENIOR LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2019
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

562 RICHMOND RD
RICHMOND HEIGHTS OH
44143-2943
US

IV. Provider business mailing address

2668 NORTHPARK DR
LAFAYETTE CO
80026-3199
US

V. Phone/Fax

Practice location:
  • Phone: 216-291-8585
  • Fax:
Mailing address:
  • Phone: 303-952-9216
  • 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: MR. JAMES PATRICK ESTES III
Title or Position: COUNSEL
Credential:
Phone: 503-620-8900