Healthcare Provider Details

I. General information

NPI: 1740397835
Provider Name (Legal Business Name): HARBORSIDE OF CLEVELAND LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27601 WESTCHESTER PKWY
WESTLAKE OH
44145-1251
US

IV. Provider business mailing address

27601 WESTCHESTER PKWY
WESTLAKE OH
44145-1251
US

V. Phone/Fax

Practice location:
  • Phone: 440-871-5900
  • Fax: 440-871-5901
Mailing address:
  • Phone: 440-871-5900
  • Fax: 440-871-5901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5159
License Number StateOH

VIII. Authorized Official

Name: MICHAEL T BERG
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 505-468-4742