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General NPI Number Information
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NPI Number | 1225299019
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Entity Type | Organization
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Legal Business Name | MYOCARE NURSING HOME INC
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Dates
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Enumeration Date | 06/24/2008
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 4401 W 150TH ST
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City | CLEVELAND
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State | OH
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Zip | 44135-1311
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Country | US
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Telephone | 216-252-7555
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Fax |
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Provider Business Mailing Address
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Address Line | 24340 SPERRY DR
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City | WESTLAKE
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State | OH
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Zip | 44145-1565
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Country | US
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Telephone | 440-617-2103
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Fax |
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Authorized Official
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Title or Position | SECRETARY TREASURER
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Name | MR. NORMAN A FOX JR.
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Credential |
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Telephone | 440-617-2103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 36D0912921
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License Number State | OH
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