Healthcare Provider Details

I. General information

NPI: 1952733479
Provider Name (Legal Business Name): WLKOP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 CROCKER RD
WESTLAKE OH
44145-6312
US

IV. Provider business mailing address

26945 AMHEARST CIR APT 209
BEACHWOOD OH
44122-7566
US

V. Phone/Fax

Practice location:
  • Phone: 440-892-2100
  • 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: AKIVA GRUNEWALD
Title or Position: MANAGER
Credential:
Phone: 216-502-2661