=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508669599
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEACHWOOD CARE GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2025
-----------------------------------------------------
Last Update Date | 03/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23311 HARVARD RD
-----------------------------------------------------
City | BEACHWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44122-6232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-839-1300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23311 HARVARD RD
-----------------------------------------------------
City | BEACHWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44122-6232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-839-1300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGIONAL DIRECTOR OPERATIONS
-----------------------------------------------------
Name | DAWN BLANKENSHIP
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 615-517-2246
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------