=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346682333
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIARWOOD LEASING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2013
-----------------------------------------------------
Last Update Date | 01/21/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3700 ENGLEWOOD DR
-----------------------------------------------------
City | STOW
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44224-3204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-688-1828
-----------------------------------------------------
Fax | 866-629-9730
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29225 CHAGRIN BLVD SUITE # 230
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44122-4645
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-658-1040
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | ELI M. GUNZBURG
-----------------------------------------------------
Credential | LNHA
-----------------------------------------------------
Telephone | 440-658-1040
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 313M00000X
-----------------------------------------------------
Taxonomy Name | Nursing Facility/Intermediate Care Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------