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General NPI Number Information
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NPI Number | 1861727844
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Entity Type | Organization
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Legal Business Name | BLOOMFIELD SENIOR LIVING OF LAKEWOOD, LLC
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Dates
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Enumeration Date | 10/09/2009
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Last Update Date | 10/25/2010
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Provider Practice Location Address
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Address Line | 1341 MARLOWE AVE
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City | LAKEWOOD
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State | OH
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Zip | 44107-2654
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Country | US
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Telephone | 216-228-2266
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Fax |
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Provider Business Mailing Address
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Address Line | 201 E OHIO ST SUITE 302
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City | CHICAGO
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State | IL
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Zip | 60611-3629
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Country | US
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Telephone | 312-854-7104
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | SCOTT KANTOR
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Credential |
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Telephone | 312-854-7104
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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 | 2014R
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License Number State | OH
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