Healthcare Provider Details

I. General information

NPI: 1598828907
Provider Name (Legal Business Name): SNF WADSWORTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 GREAT OAKS TRL
WADSWORTH OH
44281-8799
US

IV. Provider business mailing address

5625 EMERALD RIDGE PKWY
SOLON OH
44139-1860
US

V. Phone/Fax

Practice location:
  • Phone: 330-336-3472
  • Fax: 330-334-2026
Mailing address:
  • Phone: 440-498-3000
  • Fax: 440-498-8257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2350N
License Number StateOH

VIII. Authorized Official

Name: BRIAN KEITH MCMAHAN
Title or Position: CONTROLLER
Credential:
Phone: 440-498-3000