Healthcare Provider Details

I. General information

NPI: 1295578243
Provider Name (Legal Business Name): 5000 SOWUL BOULEVARD OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 SOWUL BLVD
STOW OH
44224-6092
US

IV. Provider business mailing address

30100 CHAGRIN BLVD STE 202
PEPPER PIKE OH
44124-5722
US

V. Phone/Fax

Practice location:
  • Phone: 330-653-8722
  • Fax:
Mailing address:
  • Phone:
  • 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: RACHEL FRIEDMAN
Title or Position: MANAGER
Credential:
Phone: 516-545-0980