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General NPI Number Information
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NPI Number | 1083600118
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Entity Type | Organization
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Legal Business Name | KETHLEY HOUSE @ BENJAMIN ROSE PLACE
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Dates
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Enumeration Date | 09/23/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11900 FAIRHILL RD
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City | CLEVELAND
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State | OH
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Zip | 44120-1053
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Country | US
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Telephone | 216-795-5450
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Fax | 216-795-1178
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Provider Business Mailing Address
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Address Line | 11900 FAIRHILL RD
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City | CLEVELAND
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State | OH
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Zip | 44120-1053
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Country | US
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Telephone | 216-795-5450
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Fax | 216-795-1178
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. MARY S. MARITA
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Credential | L.N.H.A.
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Telephone | 216-373-1807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 0675
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License Number State | OH
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