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General NPI Number Information
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NPI Number | 1487656773
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Entity Type | Organization
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Legal Business Name | CRESTMONT NURSING HOME NORTH CORP.
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 13330 DETROIT AVE
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City | LAKEWOOD
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State | OH
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Zip | 44107-2850
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Country | US
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Telephone | 216-228-9550
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Fax | 216-521-2193
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Provider Business Mailing Address
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Address Line | 13330 DETROIT AVE
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City | LAKEWOOD
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State | OH
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Zip | 44107-2850
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Country | US
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Telephone | 216-539-7846
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Fax | 216-521-1212
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Authorized Official
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Title or Position | OWNER
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Name | MR. ELIAS J COURY
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Credential |
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Telephone | 216-539-7846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 4284
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License Number State | OH
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