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General NPI Number Information
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NPI Number | 1225160096
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Entity Type | Organization
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Legal Business Name | BEREA LAKE TOWERS LLC
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 4 BEREA COMMONS
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City | BEREA
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State | OH
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Zip | 44017-2524
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Country | US
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Telephone | 440-243-9050
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Fax | 440-891-0196
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Provider Business Mailing Address
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Address Line | 2 BEREA CMNS STE 1
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City | BEREA
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State | OH
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Zip | 44017-2535
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Country | US
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Telephone | 440-243-5668
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Fax | 440-243-3049
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Authorized Official
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Title or Position | CEO
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Name | MR. MICHAEL ROBERT COURY
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Credential |
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Telephone | 440-243-5668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 6206
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License Number State | OH
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