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General NPI Number Information
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NPI Number | 1649764945
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Entity Type | Organization
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Legal Business Name | GATES MILLS ASSISTED LIVING LLC
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Dates
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Enumeration Date | 06/20/2018
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 6759 MAYFIELD RD
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City | MAYFIELD HEIGHTS
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State | OH
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Zip | 44124-2237
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Country | US
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Telephone | 440-461-2010
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Fax | 440-461-5949
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Provider Business Mailing Address
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Address Line | 6759 MAYFIELD RD
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City | MAYFIELD HEIGHTS
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State | OH
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Zip | 44124-2237
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Country | US
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Telephone | 440-461-2010
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Fax | 440-461-5949
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | VICKIE SHEPPARD
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Credential |
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Telephone | 440-461-2010
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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 | 2803R
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License Number State | OH
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