Healthcare Provider Details

I. General information

NPI: 1215698634
Provider Name (Legal Business Name): EMBASSY MERCER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2022
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7271 W MARKET ST
MERCER PA
16137-6608
US

IV. Provider business mailing address

25201 CHAGRIN BLVD STE 190
BEACHWOOD OH
44122-5633
US

V. Phone/Fax

Practice location:
  • Phone: 724-704-0039
  • Fax:
Mailing address:
  • Phone: 216-378-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier451510
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPA DHS

VIII. Authorized Official

Name: NICHOLAS CICCONE
Title or Position: COMPLIANCE OFFICER
Credential:
Phone: 216-378-2050