Healthcare Provider Details

I. General information

NPI: 1730334137
Provider Name (Legal Business Name): OLMSTED MANOR RETIREMENT COMMUNITY LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2008
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26612 CENTER RIDGE RD
WESTLAKE OH
44145
US

IV. Provider business mailing address

27420 MILL RD
NORTH OLMSTED OH
44070-3190
US

V. Phone/Fax

Practice location:
  • Phone: 440-250-4080
  • Fax:
Mailing address:
  • Phone: 440-779-8886
  • Fax: 440-779-9569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number2504R
License Number StateOH

VIII. Authorized Official

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