Healthcare Provider Details

I. General information

NPI: 1841551488
Provider Name (Legal Business Name): SHG WHITEHALL HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4805 LANGLEY AVE
WHITEHALL OH
43213-6125
US

IV. Provider business mailing address

26691 RICHMOND RD
BEDFORD HEIGHTS OH
44146-1421
US

V. Phone/Fax

Practice location:
  • Phone: 614-501-8271
  • Fax: 614-861-3033
Mailing address:
  • Phone: 216-292-5706
  • Fax: 216-292-2273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2288N
License Number StateOH

VIII. Authorized Official

Name: WILLIAM I. WEISBERG
Title or Position: VICE PRESIDENT
Credential:
Phone: 216-292-5706